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Periorbital cellulitis  


Preseptal cellulitis ... Periorbital cellulitis is more common in children under age 6. It can occur after a scratch or bug bite ... Periorbital cellulitis almost always improves with treatment. In rare cases, the infection may spread into the eye socket, the ...


Perianal streptococcal cellulitis  


Perianal streptococcal cellulitis is an inflammation of the anus and rectum caused by Streptococcus bacteria. ... Perianal streptococcal cellulitis usually occurs in children, often with ... or streptococcal skin infection ( impetigo ). Children may ...


Distinguishing cellulitis from its mimics.  


Distinguishing true cellulitis from its many imitators is challenging but critical if we are to avoid unnecessary use of antibiotics and delays in treatment. Common imitators of cellulitis are stasis dermatitis, lipodermatosclerosis, contact dermatitis, lymphedema, eosinophilic cellulitis, and papular urticaria. Specific criteria do not exist for the diagnosis of cellulitis, but the alert physician can find clues in the history and physical examination that point toward cellulitis. PMID:22854433

Keller, Emily C; Tomecki, Kenneth J; Alraies, M Chadi



Wells Syndrome (Eosinophilic Cellulitis)  

PubMed Central

Objective: To report a case of Wells syndrome (eosinophilic cellulitis) in a patient who was previously hospitalized twice and received several antibiotic treatments. Setting: Inpatient hospital consultation. Participant: One patient diagnosed with Wells Syndrome based on supporting clinical history, histopathological examination, and other laboratory data. Measurement: Change in signs and symptoms over time. Results: Improvement of skin lesions after administration of corticosteroids. Conclusion: Wells syndrome is a clinical condition that mimics bacterial cellulitis. It is characterized as an erythematous, edematous tender plaque with predilection for the lower extremity. The authors report this case to warn clinicians about other primary dermatological disorders that resemble infectious cellulitis in order to avoid misdiagnoses and delayed treatment.

Coloe, Jacquelyn; Peters, Sara; Zirwas, Matthew; Darabi, Kamruz



Changing Bacteriology of Periorbital Cellulitis  

Microsoft Academic Search

Study objective: Bacteremic periorbital cellulitis has traditionally been associated with Haemophilus influenzae infection, and the recommended diagnostic evaluation in young children includes blood culture and cerebrospinal fluid (CSF) analysis. The objectives of this study were to examine in pediatric patients with periorbital cellulitis (1) the prevalence of H influenzae bacteremia in the era of vaccination for H influenzae type B

Gary R Schwartz; Seth W Wright



Breast cellulitis after conservative surgery and radiotherapy  

SciTech Connect

Cellulitis is a previously unreported complication of conservative surgery and radiation therapy for early stage breast cancer. Patients who presented with breast cellulitis after conservative therapy are described. Eleven patients that developed cellulitis of the breast over a 38-month period of observation are the subject of this report. Clinical characteristics of patients with cellulitis and their treatment and outcome are reported. Potential patient and treatment-related correlates for the development of cellulitis are analyzed. The risk of cellulitis persists years after initial breast cancer therapy. The clinical course of the patients was variable: some patients required aggressive, long-duration antibiotic therapy, while others had rapid resolution with antibiotics. Three patients suffered from multiple episodes of cellulitis. Patients with breast cancer treated with conservative surgery and radiotherapy are at risk for breast cellulitis. Systematic characterization of cases of cellulitis may provide insight into diagnosis, prevention, and more effective therapy for this uncommon complication. 15 refs., 1 fig., 2 tabs.

Rescigno, J.; McCormick, B.; Brown, A.E.; Myskowski, P.L. (Cornell Univ. Medical College, New York, NY (United States))



Reactive angioendotheliomatosis presenting as cellulitis.  


Reactive angioendotheliomatosis (RAE) is a diagnostically challenging condition characterized by multiple possible clinical presentations, which makes diagnosis challenging. We present a rare case of RAE mimicking cellulitis in a 74-year-old woman with a valvular disease and also end-stage renal disease, for which she was being treated with haemodialysis. PMID:23496841

Rozenblat, M; Pessach, Y; Gat, A; Bergman, R; Sprecher, E; Goldberg, I



Bacteremic pneumococcal cellulitis compared with bacteremic cellulitis caused by Staphylococcus aureus and Streptococcus pyogenes.  


In order to better characterize bacteremic cellulitis caused by Streptococcus pneumoniae, a review was conducted of 10 cases of bacteremic pneumococcal cellulitis, which represented 0.9% of all cases of pneumococcal bacteremia (n=1,076) and 3.2% of all cases of community-acquired bacteremic cellulitis (n=312) that occurred in the Hospital de Bellvitge, Barcelona, from 1984 to 2001. In addition to these 10 cases, 28 cases of bacteremic pneumococcal cellulitis from the literature (Medline 1975-2001) were reviewed. Pneumococcal cellulitis of the face, neck, and trunk was observed more frequently in patients with systemic lupus erythematosus and hematologic disorders, while pneumococcal cellulitis of the limbs was more common in patients with diabetes, alcoholism, and parenteral drug use. In the Hospital de Bellvitge group, bacteremic cellulitis due to Streptococcus pneumoniae was more frequently associated with severe underlying diseases than that due to Staphylococcus aureus or Streptococcus pyogenes (100%, 57%, and 72%, respectively;P=0.01). A concomitant extracutaneous focus of infection (e.g., respiratory tract infection) suggesting hematogenous spread with metastatic cellulitis was more frequent in patients with pneumococcal cellulitis, while a local cutaneous entry of microorganisms was feasible in most patients with Staphylococcus aureus or Streptococcus pyogenes cellulitis. The 30-day mortality was 10% in patients with pneumococcal cellulitis, 13% in patients with Staphylococcus aureus cellulitis, and 23% in patients with Streptococcus pyogenes cellulitis (P=0.3). Thus, bacteremic pneumococcal cellulitis is an unusual manifestation of pneumococcal disease and occurs mainly in patients with severe underlying diseases. In most cases, pneumococcal cellulitis has a different pathophysiologic mechanism than cellulitis caused by Staphylococcus aureus or Streptococcus pyogenes. PMID:12783279

Capdevila, O; Grau, I; Vadillo, M; Cisnal, M; Pallares, R



Management of preseptal and orbital cellulitis  

PubMed Central

Orbital cellulitis describes an infection involving the soft tissues posterior to the orbital septum, including the fat and muscle within the bony orbit. This condition may be associated with severe sight and life-threatening complications. Despite significant advances in antimicrobial therapies and diagnostic technologies, the management of orbital cellulitis often remains challenging, and rapid diagnosis and prompt initiation of therapy are important in minimizing complications and optimizing outcomes. This review summarizes the distinctive characteristics of preseptal and orbital cellulitis, with a focus on anatomic considerations, predisposing conditions, approaches to evaluation, and management strategies.

Lee, Seongmu; Yen, Michael T.





... Common Searches Adult Strabismus Amblyopia Cataract Conjunctivitis Corneal Abrasions Dilating Eye Drops Lazy eye (defined) Pink eye ( ... Common Searches Adult Strabismus Amblyopia Cataract Conjunctivitis Corneal Abrasions Dilating Eye Drops Lazy eye (defined) Pink eye ( ...




... rare cases, the infection can spread to the deep layer of tissue called the fascial lining. Flesh- ... called necrotizing fasciitis, is an example of a deep-layer infection. It represents an extreme emergency. Preparing ...




... edges of the redness with a pen, to see if the redness goes past the marked border over the next several days. Tests that may be done: Blood culture Complete blood count ( CBC ) Culture of any fluid ...




... aureus (CA-MRSA) is a strain of "staph" bacteria that is resistant to antibiotics in the penicillin family. This class of antibiotics ... infections in the general population. While CA-MRSA bacteria are resistant to penicillin ... antibiotics, most CA-MRSA infections can easily be treated ...


Cellulitis in Japanese quail (Coturnix coturnix japonica).  


A case of cellulitis was observed in Japanese quail (Coturnix coturnix japonica) reared for commercial meat production. This condition in Japanese quail has not been reported in the literature. This incident was the first, and to date only, occurrence of cellulitis in this processing plant. The cellulitis lesions were localized to the subcutis overlying the breast and inner thigh. Carcasses of processed birds and live birds from the affected farm were presented to the Poultry Diagnostic and Research Center, University of Georgia. Escherichia coli was cultured from the lesion. The affected live birds displayed lameness and had osteomyelitis. Pasteurella multocida serotype 3,4 was cultured from the liver and bone marrow of affected birds. Approximately 4.61% of the processed carcasses from the flock were condemned because of cellulitis. This represented a 10fold increase from the typical condemnation rate. Further investigation revealed birds were placed in higher than normal density; therefore, we theorize that the concurrent pasteurellosis and increased placement density resulted in the cellulitis condition. PMID:12713180

Burns, Karen E; Otalora, Raul; Glisson, John R; Hofacre, Charles L


Computerized tomography in the diagnosis and treatment of orbital cellulitis  

Microsoft Academic Search

Acute sinusitis remaines the major cause of orbital cellulitis in children, despite the extensive use of antibiotics. Staging\\u000a of orbital cellulitis on the basis of clinical signs is difficult but is easily achieved by computerized tomography. The CT\\u000a findings in a series of 9 children with orbital cellulitis in different stages are reported. The information obtained by CT\\u000a contributes to

M. Hirsch; T. Lifshitz



[Neonatal cellulitis caused by group B Streptococcus].  


Dermohypodermitis (cellulitis) in newborn infants and in infants aged up to 3 months is uncommon and often not typical. Because group B Streptococcus is known to induce rapid life-threatening complications, early diagnosis leading to emergency treatment is of utmost importance. We report on the case of a 14-day-old girl, initially admitted for viral bronchiolitis with suspected bacterial pulmonary infection, in the absence of any cutaneous injury. The disease actually was cellulitis of the face, caused by group B Streptococcus. The baby presented with a severe septic clinical condition. Early treatment with antibiotics (intravenous amoxicillin for 10 days) allowed a favorable course, with rapid control of the sepsis and regression of the submandibular tumefaction. PMID:22939649

Breinig, S; Roques-Gineste, M; Marcoux, M-O; Bloom, M-C



Blindness resulting from orbital cellulitis following rhinoplasty.  


Ophthalmic complications occurring after non-ophthalmic surgery are rare. We present a case of orbital cellulitis in a 24-year-old woman, who had undergone augmentation rhinoplasty in combination with breast augmentation. Symptoms included pain, swelling, erythema and eventual loss of vision in the left eye. Intravenous administration of antibiotics did not halt the rapid progression of this infection. On the sixth postoperative day, the patient underwent left-orbital evisceration to prevent the spread of infection to other organ systems. Despite aggressive therapy, the sequela was permanent, unilateral blindness. Orbital cellulitis in aesthetic surgery is extremely rare. In patients undergoing rhinoplasties that may be prolonged due to other concomitant cosmetic procedures, aseptic preoperative preparation and careful monitoring for signs of orbital infection are recommended. PMID:23402932

Lee, Kyung Mook; Han, Sang Chul; Ho, Samuel Y M; Kim, Jeong Tae; Kim, Youn Hwan



Odontogenic infection causing orbital cellulitis in a pediatric patient.  


Odontogenic abscess can become an orbital cellulitis, causing potentially serious intracranial and orbital complications. The full clinical complications from odontogenic orbital cellulitis in a pediatric patient are rarely seen daily in hospital emergency departments. Thus, odontogenic orbital cellulitis still remains a rarity, resulting in a medical challenge. With this in mind, this study aimed to describe a case of periorbital and orbital cellulitis resulting from odontogenic origin in a 6-year-old patient who was successfully treated by performing intravenous antibiotic administration combined with surgical drainage. PMID:24036835

de Assis-Costa, Marcelo Dias Moreira; Santos, George Soares; Maciel, Jucileia; Sonoda, Celso Koogi; de Melo, Willian Morais



[Staphylococcus aureus methicillin-resistant community acquired neonatal orbital cellulitis].  


Orbital cellulitis typically occurs in older children, but it can occasionally affect infants and neonates. Staphylococcus aureus is the main pathogen isolated. Outcome depends on an adequate initial approach. We report three neonates with orbital cellulitis caused by community-associated MRSA. PMID:22307432

Pérez, M Guadalupe; Castro, Graciela; Mansilla, Celeste; Kaldzielski, Carina; Salas, Gisela; Rosanova, María Teresa; Berberian, Griselda


[Staphylococcus aureus methicillin-resistant community acquired neonatal orbital cellulitis].  


Orbital cellulitis typically occurs in older children, but it can occasionally affect infants and neonates. Staphylococcus aureus is the main pathogen isolated. Outcome depends on an adequate initial approach. We report three neonates with orbital cellulitis caused by community-associated MRSA. PMID:23568077

Pérez, M Guadalupe; Castro, Graciela; Mansilla, Celeste; Kaldzielski, Carina; Salas, Gisela; Rosanova, María Teresa; Berberian, Griselda



Management of patients with cellulitis of the lower limb.  


This article aims to help practitioners develop an understanding of cellulitis of the lower limb. It focuses on the identification of cellulitis, differentiating it from other common conditions, and discusses treatment and management strategies. The article includes information for prevention and early recognition of the condition in an attempt to reduce frequent recurrences. PMID:22204111

Beasley, Alison


Escherichia coli Cellulitis in Children With Idiopathic Nephrotic Syndrome  

Microsoft Academic Search

Although Streptococcus pneumoniae is traditionally considered the preponderant bacterial pathogen in children with nephrotic syndrome, recent data suggest an increase of infections with encapsulated gram-negative organisms. We report two children with idiopathic nephrotic syndrome in relapse who developed spontaneous Escherichia coli cellulitis. The organism was recovered from the cellulitis tissue aspirate of one, and from the blood of the other.

Basim I. Asmar; Bassam N. Bashour; Larry E. Fleischmann



Familial eosinophilic cellulitis, dysmorphic habitus, and mental retardation  

Microsoft Academic Search

Background: Eosinophilic cellulitis is a polymorphous, chronic disease characterized by eosinophil infiltration and granulomatous inflammation. Objective: Our purpose was to describe the clinical, histologic, and immunohistologic findings in three family members who have had eosinophilic cellulitis since childhood associated with mental retardation and abnormal body habitus. Methods: Family members were evaluated. Multiple skin biopsy specimens were obtained and examined after

Mark D. P. Davis; A. C. Brown; R. Dwain Blackston; Claudia Gaughf; Ellen A. Peterson; Gerald J. Gleich; Kristin M. Leiferman



Activité aromatase dans les cellules germinales mâles: quelle signification fonctionnelle?  

Microsoft Academic Search

Resume  La capacité de la gonade mâle à convertir les androgènes en oestrogènes est bien établie: cette transformation est catalysée\\u000a par l'aromatase composée d'une glycoprotéine enzymatique microsomiale, le cytochrome P450 aromatase (P450arom) et d'une réductase\\u000a ubiquitaire. Dans les cellules testiculaires du rat mature, le P450arom a été immunolocalisé principalement dans les cellules\\u000a de Leydig mais également dans les cellules germinales chez

S. Carreau; J. Levallet



Skin and Soft Tissue Infection (Cellulitis) (Beyond the Basics)  


... Basics) Patient information: Chronic granulomatous disease (The Basics) Pseudomonas aeruginosa skin, soft tissue, and bone infections Skin abscesses, ... diabetic infections of the lower extremities Orbital cellulitis Pseudomonas aeruginosa skin, soft tissue, and bone infections Soft tissue ...


Serratia marcescens: an unusual pathogen associated with snakebite cellulitis.  


This study reports a case of Serratia marcescens cellulitis following a snakebite in a 50-year-old woman. The bite was on the dorsum of the right hand with symptoms of envenomation. She developed swelling and cellulitis with tissue necrosis. Wound debridement was performed.  Pus and tissue biopsy cultures yielded Serratia marcescens sensitive to fluoroquinolones, aminoglycosides, third-generation cephalosporins and carbapenems. The patient responded to anti-snake venom (ASV) therapy, ciprofloxacin, local wound management and recovered uneventfully. PMID:23416662

Subramani, Parimala; Narasimhamurthy, Gokul Bindiganavile; Ashokan, Bhaskaran; Madappa, Beena Prasavangada



[Endoscopic treatment of orbital cellulitis in pediatric patients: transethmoidal approach].  


Orbital cellulitis is a septic process of the soft tissues behind the orbital septum and is the most frequent cause of the monolateral exophthalmos in pediatrics. Approximately 90% of the orbital cellulitis in pediatrics are associated to acute ethmoiditis. From the 01.01.2001 to 31.12.2010 we treated 36 patients, less than 18 years-old affected by Chandler stage II, III, or IV orbital cellulitis. The inflammation was resolved medically in 6 patients. In the 30 cases that showed no improvement in 48-72 h, an endoscopic drainage of the pus was performed by the transethmoidal route. In children, an adenoidectomy should be included, in order to eliminate eventual infections of this lymphatic organ. Endoscopic treatment has resulted in rapid resolution of disease without any complications. In addition, postoperative discomfort is minimal, with a rapid return to daily activities. PMID:23768475

Cavaliere, M; Volino, F; Parente, G; Troisi, S; Iemma, M



Nonpigmented Chromobacterium violaceum bacteremic cellulitis after fish bite.  


A case of nonpigmented Chromobacterium violaceum bacteremic cellulitis after fish bite in Taiwan is reported. The patient was successfully treated with ciprofloxacin and doxycycline for an extended period. Chromobacterium violaceum should be listed in the differential diagnosis of patients with nonspecific cellulitis associated with marked leukocytosis and rapid progression to septicemia either with or without a distinct history of exposure to water or soil. A combination of prompt diagnosis, optimal antimicrobial therapy, and adequate therapeutic duration for C violaceum infection is the key for successful therapy. PMID:21524969

Yang, Ching-Huei



[Cervicofacial cellulitis in Ouagadougou, Burkina Faso: report of 26 cases].  


Cervicofacial cellulitis is still observed in Burkina Faso and can be severe. The aim of this study was to review diagnostic and therapeutic challenges associated with management of cericofacial cellulitis in our region where medical facilities are poor. A retrospective study of patients treated between January 1999 and December 2008 was performed. A total of 26 cases of cervicofacial cellulites were compiled. All patients underwent broad spectrum antibiotherapy associated imidazols. Surgical treatment was performed in 60% of the cases. Early diagnosis and treatment is essential for favorable outcome. PMID:22235638

Sereme, M; Ouedraogo, B; Gyebre, Y; Ouattara, M; Ouoba, K



Cellulitis and the Prevalence of Deep Vein Thrombnosis  

Microsoft Academic Search

From February, 1994, to August, 1995, we reviewed the venous duplex ultrasound findings of 207 consecutive patients who presented with clinically evident lower leg cellulitis to determine if thrombophlebitis plaued a role in this entity. All patients had a recent onset of intense erythema of the lower leg with associated pitting edema and diffuse painful cutaneous or subcutaneous tenderness. One

Phillip J. Bendick



Ethmoid Sinus Osteoma Presenting as Epiphora and Orbital Cellulitis  

Microsoft Academic Search

Paranasal sinus osteoma is a slow-growing, benign, encapsulated bony tumor that may be commonly asymptomatic, being detected incidentally in 1% of plain sinus radiographs or in 3% of sinus computerized tomographic scans. In a patient presenting with orbital cellulitis and epiphora, computed tomography disclosed a large osteoma of the ethmoid sinus. Excision of the osteoma allowed recovery of vision, return

Ahmad M Mansour; Haytham Salti; Sami Uwaydat; Rola Dakroub; Ziad Bashshour



Genetic Susceptibility to Non-Necrotizing Erysipelas/Cellulitis  

PubMed Central

Background Bacterial non-necrotizing erysipelas and cellulitis are often recurring, diffusely spreading infections of the skin and subcutaneous tissues caused most commonly by streptococci. Host genetic factors influence infection susceptibility but no extensive studies on the genetic determinants of human erysipelas exist. Methods We performed genome-wide linkage with the 10,000 variant Human Mapping Array (HMA10K) array on 52 Finnish families with multiple erysipelas cases followed by microsatellite fine mapping of suggestive linkage peaks. A scan with the HMA250K array was subsequently performed with a subset of cases and controls. Results Significant linkage was found at 9q34 (nonparametric multipoint linkage score (NPLall) 3.84, p?=?0.026), which is syntenic to a quantitative trait locus for susceptibility to group A streptococci infections on chromosome 2 in mouse. Sequencing of candidate genes in the 9q34 region did not conclusively associate any to erysipelas/cellulitis susceptibility. Suggestive linkage (NPLall>3.0) was found at three loci: 3q22-24, 21q22, and 22q13. A subsequent denser genome scan with the HMA250K array supported the 3q22 locus, in which several SNPs in the promoter of AGTR1 (Angiotensin II receptor type I) suggestively associated with erysipelas/cellulitis susceptibility. Conclusions Specific host genetic factors may cause erysipelas/cellulitis susceptibility in humans.

Hannula-Jouppi, Katariina; Massinen, Satu; Siljander, Tuula; Makela, Siru; Kivinen, Katja; Leinonen, Rasko; Jiao, Hong; Aitos, Paivi; Karppelin, Matti; Vuopio, Jaana; Syrjanen, Jaana; Kere, Juha



Abdominal wall cellulitis and sepsis secondary to percutaneous cecostomy  

Microsoft Academic Search

We report 1 case of abdominal wall cellulitis and sepsis which developed following percutaneous placement of a Cope catheter\\u000a for cecal decompression in a patient with Ogilvie's syndrome. This case highlights that further laboratory investigation and\\u000a clinical evaluation are needed to determine the safest and most efficacious technique of percutaneous drainage.

Thomas J. Maginot; Philip N. Cascade



Facial cellulitis secondary to dens invaginatus: a case report.  


We describe a case of dens invaginatus in an unerupted permanent maxillary lateral incisor, which led to facial cellulitis in a 10-year-old girl. We review the importance of recognizing dens invaginatus and present strategies for preventing loss of vitality in the affected tooth. PMID:21675539

Arsenault, Murielle; Anderson, Ross D; Dyment, Heather; MacLellan, Jennifer; Doyle, Tracy



Histopathologic and bacteriologic evaluations of cellulitis detected in legs and caudal abdominal regions of turkeys.  


The objective of this study was to identify the causative agent of cellulitis in turkeys. Eighteen flocks from nine producers were sampled at the local processing plant, and 37 birds with cellulitis on legs or caudal thoracic area were obtained. None of the 37 birds with cellulitis had lesions in other organs. On gross examination, lesions were categorized into two groups: cellulitis with unopened skin lesions (type a) and cellulitis with opened skin lesions (type b). Histopathologically, cellulitis with unopened skin lesions had dermal necrosis with underlying fibrin and inflammatory exudate but cellulitis with open skin lesions had chronic granulomatous/granulation tissue-type reaction associated with foreign material. A complete bacteriologic study was conducted on 25 of 37 birds. Bacteria were isolated from 12 of the 25 birds with cellulitis lesions. No aerobic, microaerophilic, or anaerobic bacteria were isolated from the remaining 13 birds with cellulitis lesions. Escherichia coli was isolated in low numbers in mixed cultures with Proteus mirabilis, Lactobacillus spp., Klebsiella spp., and Staphylococcus spp. in 9 of 12 lesions. The remaining few cases yielded P. mirabilis in pure culture or in mixed culture with Pseudomonas aeruginosa. Types a and b cellulitis lesions in turkeys could be associated with primary contact dermatitis and skin abrasions, respectively. Their occurrence is likely associated with different management practices. PMID:11922333

Gomis, S; Amoako, A K; Ngeleka, A M; Belanger, L; Althouse, B; Kumor, L; Waters, E; Stephens, S; Riddell, C; Potter, A; Allan, B


Pneumococcal sepsis, peritonitis, and cellulitis at the first episode of nephrotic syndrome.  


Bacterial infections are common in patients with nephrotic syndrome, including peritonitis, sepsis, meningitis, urinary tract infection, and cellulitis. An 8-year-old boy presented with colicky abdominal pain, vomiting, swollen and painful erythematous lesions around the umbilicus and in anterior surface of left thigh (cellulitis), mild generalized edema, and ascites. The microorganism isolated from peritoneal fluid and blood cultures was Pneumococcus. Association of pneumococcal sepsis, peritonitis, and cellulitis has been rarely reported in nephrotic syndrome. PMID:24072154

Naseri, Mitra



Florid osseous dysplasia: Report of a case presenting acute cellulitis  

Microsoft Academic Search

In this review, we examined a 45-year-old Asian man who had been diagnosed with florid osseous dysplasia (FOD) of the mandible and acute perimandibular cellulitis. This presentation occurred after a history of off-and-on swellings of the jaw and multiple treatments received at another hospital. An aggressive resection of the jaw was planned; however, the patient denied the treatment and came

Poramate Pitak-Arnnop; Kittipong Dhanuthai; André Chaine; Jacques-Charles Bertrand; Chloé Bertolus


Nocardia brasiliensis Cellulitis in a Heart Transplant Patient  

PubMed Central

Three months after undergoing heart transplantation, a 55-year-old man presented with N. brasiliensis cellulitis resulting from a splinter wound acquired during yard work. Surgical débridement was necessary before the infection responded to medical treatment. Although pulmonary nocardiosis is a well-documented complication of immunosuppressive therapy, this is the 1st report of a nocardial infection associated with primary skin involvement in a heart transplant patient. (Texas Heart Institute Journal 1990;17:133-5)

Sinnott, John T.; Holt, Douglas A.; Alverez, Carlos; Greene, John; Sweeney, Michael S.



Injectable silicone: Cause of facial nodules, cellulitis, ulceration, and migration  

Microsoft Academic Search

Fifty-four patients with problems following “medical grade” silicone injections into the face and legs were seen from 1974\\u000a until 1995. Complications consisted of chronic cellulitis, nodules, foreign body reactions, and movement of material to near\\u000a and distant parts of the body. These difficulties usually demonstrated themselves many years after injection. It is suggested\\u000a that problems occur despite good technique, good

Marvin J. Rapaport; Charles Vinnik; Harvey Zarem



The Risk of Cellulitis in Cirrhotic Patients: A Nationwide Population-Based Study in Taiwan  

PubMed Central

Background/Aims Cellulitis is a common infectious disease. However, the risk of cellulitis in cirrhotic patients is not well established, and whether liver cirrhosis is a risk factor for cellulitis remains unknown. This study evaluated the relationship between cellulitis and liver cirrhosis. Methods The National Health Insurance Database, which was derived from the Taiwan National Health Insurance program, was used to identify patients. The study group consisted of 39,966 patients with liver cirrhosis, and the comparison group consisted of 39,701 randomly selected age- and sex-matched patients. Results During the 3-year follow-up period, 2,674 (6.7%) patients with liver cirrhosis developed cellulitis, and 1,587 (4.0%) patients without liver cirrhosis developed cellulitis (p<0.001). Following a Cox's regression analysis adjusted for age, sex, and underlying medical disorders, the cirrhotic patients demonstrated a greater risk for the occurrence of cellulitis than the non-cirrhotic patients during the 3-year period (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.55 to 1.77; p<0.001). Additionally, cirrhotic patients with complications also had a greater risk for the occurrence of cellulitis than those patients without complications (HR, 1.23; 95% CI, 1.14 to 1.33; p<0.001). Conclusions We conclude that cirrhotic patients have a greater risk of cellulitis than non-cirrhotic patients.

Lin, Ming-Nan; Tsai, Chen-Chi; Tsai, Chih-Chun



Leclercia adecarboxylata cellulitis in a child with acute lymphoblastic leukemia.  


Leclercia adecarboxylata is a rare, gram-negative rod that has been infrequently reported in the literature. The organism has been documented to cause solitary infections in immunocompromised hosts and polymicrobial wound infections in the immunocompetent. We present a case of an 8-year-old boy with significant past medical history of acute lymphoblastic leukemia who developed cellulitis due to local infection by L. adecarboxylata. This case is presented to raise awareness of this rare organism's ability to cause common cutaneous disease, especially in the immunocompromised. PMID:21385207

Shah, Avnee; Nguyen, Josephine; Sullivan, Lisa M; Chikwava, Kudakwashe R; Yan, Albert C; Treat, James R



Le contrôle de commutations dans une cellule bidirectionnelle bicommandable  

NASA Astrophysics Data System (ADS)

A Power electronics static converter modulate the energy flowing between two different source types. This induce constraints in converter topology which need to be taken into account to drive the switches specially during the changeover between two switches belonging to the same cell. If the control logic is well known when using current or voltage bidirectionnal switches, we propose a method which fits to bidrivable, current and voltage bidirectionnal switches. Petri net are usefull tools to describe the switches themselves. Aplied to the cell description they permit us to generate a component logic drive in respect with energy constraints. Un convertisseur statique réalise une fonction de modulation de l'énergie transitant entre deux sources de nature différente. La nécessaire continuité énergétique induit des contraintes dans la topologie du convertisseur qui se répercutent sur la commande des composants qui le constituent, notamment lors de la phase de commutation entre deux interrupteurs d'une même cellule. Si les principes de commande sont bien connus pour les interrupteurs bidirectionnels en courant ou en tension, nous proposons dans cet article une méthode s'appliquant aux interrupteurs bicommandables et bidirectionnels à la fois en courant et en tension. Les réseaux de Petri constituent d'abord un outil de description précis des interrupteurs. Appliqués ensuite à la description du fonctionnement d'une cellule de commutation, ils deviennent alors un outil de synthèse conduisant à l'élaboration d'une logique de commande respectant les contraintes énergétiques dans tous les cas de figure.

Guillaud, X.; Deleu, A.; Degobert, P.; Hautier, J. P.




PubMed Central

Acetaminophen is a widely used analgesic drug. Its adverse reactions are rare but severe. An 89-year-old man developed an indurated edematous and erythematous plaque on his left arm 1 day after acetaminophen ingestion. Cellulitis was suspected and antibiotictherapy was started but there was no improvement of the rash; there was a spectacular extension of the lesion with occurrence of flaccid vesicles and blisters in the affected sites. The diagnosis of generalized-bullous-fixed drug eruption induced by acetaminophen was considered especially with a reported history of a previous milder reaction occurring in the same site. Acetaminophen was withdrawn and the rash improved significantly. According to the Naranjo probability scale, the eruption experienced by the patient was probably due to acetaminophen. Clinicians should be aware of the ability of acetaminophen to induce fixed drug eruption that may clinically take several aspects and may be misdiagnosed.

Fathallah, Neila; Salem, Chaker Ben; Slim, Raoudha; Boussofara, Lobna; Ghariani, Najet; Bouraoui, Kamel



Case report of orbital cellulitis and necrotizing fasciitis from melioidosis.  


A 48-year-old Thai male farmer presented with progressive swelling of the right eyelid and high-grade fever. His visual acuity declined and the right side of his forehead developed a necrotic skin lesion with a purulent discharge. CT of the orbits suggested orbital cellulitis with subperiosteal abscess. Intravenous ceftriaxone and clindamycin were given empirically but then switched to vancomycin and meropenem because of rapid deterioration together with clinical sepsis. Burkholderia pseudomallei was isolated from the blood 3 days after the treatment, and the antibiotics were then switched to intravenous ceftazidime. The liver enzymes were elevated, and imaging of the abdomen revealed liver and splenic abscesses. After 14 days, the patient showed marked clinical improvement, became afebrile, and regained his OD visual acuity. A repeat CT of the orbit showed improvement with no subperiosteal abscess. The antibiotic was then switched to oral trimethoprim/sulfamethoxazole in combination with doxycycline for 6 months. PMID:23303132

Saonanon, Preamjit; Tirakunwichcha, Suppapong; Chierakul, Wirongrong


Early recognition and successful management of pelvic cellulitis following hemorrhoidal banding  

Microsoft Academic Search

Reports have focused attention on a rare but potentially serious complication following rubber band ligation of internal hemorrhoids:\\u000a pelvic cellulitis with progression to shock and death. This report documents the successful treatment of pelvic cellulitis.\\u000a The timely use of broad-spectrum antibiotics at an early stage is critical. Emphasis is placed on early recognition and treatment\\u000a of this potentially fatal complication.

Lucius D. Clay; John J. White; J. Thomas Davidson; James J. Chandler



Phenoxyethanol is effective topical therapy of gram-negative cellulitis in neutropenic patients.  


In neutropenic patients cellulitis caused by Gram-negative organisms may prove difficult to control and cause considerable tissue damage. Phenoxyethanol has activity against a range of bacteria, including Pseudomonas aeruginosa, and is absorbed by intact skin. Three severely neutropenic patients are described in whom cellulitis failed to respond to appropriate intravenous antibiotics. However the topical application of phenoxyethanol solution gave prompt local control. This cheap and nontoxic agent may give dramatic improvement in this difficult clinical situation. PMID:7693803

Mitchell, P; Powles, R; Rege, K; Treleaven, J; Catovsky, D; Mehta, J; Jameson, B



Prevalence of concurrent deep vein thrombosis in patients with lower limb cellulitis: a prospective cohort study  

PubMed Central

Background Lower limb cellulitis and deep vein thrombosis share clinical features and investigation of patients with cellulitis for concurrent DVT is common. The prevalence of DVT in this group is uncertain. This study aimed to determine the prevalence of deep vein thrombosis (DVT) in patients with lower limb cellulitis and to investigate the utility of applying the Wells algorithm to this patient group. Methods Patients admitted with lower limb cellulitis prospectively underwent a likelihood assessment for DVT using the Wells criteria followed by investigation with D-dimer and ultrasonography of ipsilateral femoral veins as appropriate. Diagnoses of contralateral DVT or pulmonary embolism during admission were recorded. Results 200 patients assessed for DVT. 20% of subjects were high risk by Wells criteria. D-dimer was elevated in 74% and 79% underwent insonation of the affected leg. Ipsilateral DVT was found in 1 patient (0.5%) and non-ipsilateral VTE in a further 2 (1%). Conclusions Deep vein thrombosis rarely occurs concurrently with lower limb cellulitis. The Wells score substantially overestimates the likelihood of DVT due to an overlap of clinical signs. Investigation for DVT in patients with cellulitis is likely to yield few diagnoses and is not warranted in the absence of a hypercoaguable state. Trial registration ACTRN: 12610000792022 (



Antimicrobial activity against CA-MRSA and treatment of uncomplicated nonpurulent cellulitis.  


Evaluation of: Pallin DJ, Binder WD, Allen MB et al. Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clin. Infect. Dis. 56(12), 1754-1762 (2013). The rise of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the empirical antimicrobial treatment of cellulitis. CA-MRSA is frequently the cause of purulent infections, to include purulent cellulitis. The role of CA-MRSA in nonpurulent cellulitis is less clear. Published clinical practice guidelines suggest that CA-MRSA plays only a minor role in nonpurulent cellulitis and that initial treatment should be primarily directed at ?-hemolytic streptococci. Until now, there have been no data from prospective randomized control trials to support this recommendation. In this review, we examine the findings from a recent prospective, double-blind, randomized controlled trial that refutes the need for empirical coverage of CA-MRSA when treating nonpurulent cellulitis. PMID:23944241

Griffith, Matthew E; Ellis, Michael W



Chronic Dermatomycoses of the Foot as Risk Factors for Acute Bacterial Cellulitis of the Leg: A Case-Control Study  

Microsoft Academic Search

Objective: To assess the role of foot dermatomycosis (tinea pedis and onychomycosis) and other candidate risk factors in the development of acute bacterial cellulitis of the leg. Methods: A case-control study, including 243 patients (cases) with acute bacterial cellulitis of the leg and 467 controls, 2 per case, individually matched for gender, age (±5 years), hospital and admission date (±2

Jean-Claude Roujeau; Bardur Sigurgeirsson; Hans-Christian Korting; Helmut Kerl; Carle Paul



Delayed breast cellulitis: An evolving complication of breast conservation  

SciTech Connect

Purpose: Delayed breast cellulitis (DBC) is characterized by the late onset of breast erythema, edema, tenderness, and warmth. This retrospective study analyzes the risk factors and clinical course of DBC. Methods and Materials: From 1985 through 2004, 580 sequential women with 601 stage T0-2N0-1 breast cancers underwent breast conserving therapy. Cases of DBC were identified according to accepted clinical criteria: diffuse breast erythema, edema, tenderness, and warmth occurring >3 months after definitive surgery and >3 weeks after radiotherapy. Potential risk factors analyzed included patient comorbidity, operative technique, acute complications, and details of adjunctive therapy. Response to treatment and long-term outcome were analyzed to characterize the natural course of this syndrome. Results: Of the 601 cases, 16%, 52%, and 32% were Stage 0, I, and II, respectively. The overall incidence of DBC was 8% (50/601). Obesity, ecchymoses, T stage, the presence and aspiration of a breast hematoma/seroma, removal of >5 axillary lymph nodes, and arm lymphedema were significantly associated with DBC. The median time to onset of DBC from the date of definitive surgery was 226 days. Ninety-two percent of DBC patients were empirically treated with antibiotics. Fourteen percent required more invasive intervention. Twenty-two percent had recurrent episodes of DBC. Ultimately, 2 patients (4%) underwent mastectomy for intractable breast pain related to DBC. Conclusion: Although multifactorial, we believe DBC is primarily related to a bacterial infection in the setting of impaired lymphatic drainage and may appear months after completion of radiotherapy. Invasive testing before a trial of antibiotics is generally not recommended.

Indelicato, Daniel J. [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL (United States); Grobmyer, Stephen R. [Department of Surgery, University of Florida, Gainesville, FL (United States); Newlin, Heather [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL (United States); Morris, Christopher G. [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL (United States); Haigh, Linda S. [Department of Surgery, University of Florida College of Medicine, Jacksonville, FL (United States); Copeland, Edward M. [Department of Surgery, University of Florida, Gainesville, FL (United States); Mendenhall, Nancy Price [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL (United States)]. E-mail:



Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report  

Microsoft Academic Search

BACKGROUND: Cryptococcus neoformans is an encapsulated yeast and the most frequent cryptococcal species found in humans. Cryptococcosis is considered an opportunistic infection as it affects mainly immunosuppressed individuals. In humans, C. neoformans causes three types of infections: pulmonary cryptococcosis, cryptococcal meningitis and wound or cutaneous cryptococcosis. CASE PRESENTATION: An 81-year-old woman developed severe necrotizing cellulitis on her left arm without

Corina Probst; Georg Pongratz; Silvia Capellino; Rolf M Szeimies; Jürgen Schölmerich; Martin Fleck; Bernd Salzberger; Boris Ehrenstein



The Effect of Soft-tissue Ultrasound on the Management of Cellulitis in the Emergency Department  

Microsoft Academic Search

Objectives: To evaluate the effect of diagnostic soft-tissue ultrasound (US) on management of emergency department (ED) patients with clinical cellulitis. Methods: This was a prospective observational study in an urban ED of adult patients with clinical soft- tissue infection without obvious abscess. The treating physician's pretest opinions regarding the need for further drainage procedures and the probability of subcutaneous fluid

Vivek S. Tayal; Nael Hasan; H. James Norton; Christian A. Tomaszewski



L'effet de p53 sur la radiosensibilité des cellules humaines normales et cancéreuses  

NASA Astrophysics Data System (ADS)

The radiosensitivity of normal human fibroblasts in p53 dependent and associated with the loss of cells from the cycling population as the result of an irreversible G1 arrest; cells lacking normal p53 function show no arrest and are more radioresistant. Under conditions in which the repair potentially lethal radiation damage is facilitated, the fraction of cells arrested in G1 is reduced and survival is enhanced. The response of human tumor cells differs significantly. The radiation-induced G1 arrest is minimal or absent in p53+ tumor cells, and loss of normal p53 function has no consistent effect on their radiosensitivity. These results suggest that p53 status may not be a useful predictive marker for the response of human solid tumors to radiation therapy. La radiosensibilité des fibroblastes diploïdes humains est liée à l'expression de p53, et à la perte de cellules en cycle résultant d'un arrêt irréversible en phase G1 ; dans les cellules n'ayant pas une fonction p53 normale, on ne constate aucun arrêt, et elles sont plus radio-résistantes. Dans des conditions favorables à la réparation de lésions potentiellement léthales dues à l'irradiation, la proportion de cellules bloquées en phase G1 baisse, et les chances de survie sont accrues. Bien différente est la réaction des cellules cancéreuses humaines. Le blocage par irradiation en phase G1 est minime ou inexistant dans les cellules cancéreuses p53^+, et la perte de la fonction normale p53 n'a pas d'effet constant sur leur radiosensibilité. Ces résultats laissent penser que l'expression de p53 n'est pas un indice fiable permettant de prévoir la réaction des tumeurs solides à la radiothérapie.

Little, J. B.; Li, C. Y.; Nagasawa, H.; Huang, H.



Poor Dental Hygiene in Pregnancy Leading to Submandibular Cellulitis and Intrauterine Fetal Demise: Case Report and Literature Review  

PubMed Central

Ludwig's angina is an infectious process involving submandibular, sublingual, and submental spaces that can rapidly progress to hemodynamic instability and airway obstruction. A 38-year-old unbooked multipara of low socioeconomic status with a poor oral and dental hygiene presented with bilateral submandibular cellulitis and intrauterine fetal demise. She delivered vaginally, and subsequently drainage was done for cellulitis. The report highlights the importance of dental hygiene during pregnancy, lest life-threatening complications like Ludwig's angina occur, complicating the course of pregnancy.

Mukherjee, Soma; Sharma, Surbhi; Maru, Laxmi



Focal dermatitis and cellulitis in broiler chickens: bacteriological and pathological findings.  


Involvement of aerobic bacteria, especially Escherichia coli, in lesions of cellulitis in broiler chickens was investigated. Samples of subcutaneous caseous material for bacteriological examination were collected aseptically at the slaughterhouse from 109 broilers with lesions. Skin tissue was taken from five of these birds for histopathological examination. In 96 of the 109 (88.1%) broilers sampled, E. coli was isolated from the lesion, and in 60 of these birds it was the only bacterial species found. In 33 broilers, Streptococcus dysgalactiae was found along with E. coli. Although serotype O78 was isolated the most frequently, numerous other serotypes were found; no correlation could be established between the size of the lesions and the serotype isolated. The microscopic lesions were characterized by thickening of the dermis with a granulomatous inflammatory reaction. This study confirms the frequent association of E. coli with cellulitis lesions in broiler chickens and reports the frequent isolation of S. dysgalactiae from the lesion. PMID:8257380

Messier, S; Quessy, S; Robinson, Y; Devriese, L A; Hommez, J; Fairbrother, J M


Metabolismo di cellule adipose umane isolate in vitro. I. Effetto del glucosio e dell'Insulina  

Microsoft Academic Search

Riassunto L'insulina stimola l'incorporazione dell' 114C del glucosio nel CO2 prodotto da cellule adipose umane isolatein vitro. Tale effetto sembra essere evidente solo con concentrazioni abbastanza elevate dell'ormone, nelle condizioni sperimentali descritte nel presente lavoro. Analogamente, anche l'effetto antilipolitico dell'insulina è evidenziabile, in modesta entità, solo con concentrazioni relativamente elevate dell'ormone nelmedium di incubazione. La presenza di glucosio nelmedium di

Guido Pozza; Alberto Ghidoni; Edda Sanesi; Augusta Pappalettera; Angela Tognetti



Factors Associated with Complications and Mortality in Adult Patients Hospitalized for Infectious Cellulitis  

Microsoft Academic Search

  \\u000a The aim of this study was to analyze medical outcomes, including risks for complications and mortality, in 332 adult patients\\u000a hospitalized for cellulitis. The infection was documented microbiologically in 128 cases (39%). Staphylococcus aureus (46 cases) and Streptococcus pyogenes (22 cases) were the most frequent causative pathogens. Overall, 63 patients (19%) were discharged early (?4 days) and 166\\u000a patients

J. Carratalà; B. Rosón; N. Fernández-Sabé; E. Shaw; O. del Rio; A. Rivera; F. Gudiol



Eosinophilic Cellulitis (Wells’ Syndrome): Ultrastructural Study of a Case with Circulating Immune Complexes  

Microsoft Academic Search

A 42-year-old woman was observed during 3 bouts of eosinophilic cellulitis over a 6-year-period. Skin biopsies were taken at each relapse and processed for histological, immunofluorescent and ultrastructural studies. Histologically the eosinophilic infiltrate extended to the deep dermis and the subcutaneous fat. High levels of circulating immune complexes, and complement and IgG deposits around the vessels were detected for as

M. C. Ferrier; A. Janin-Mercier; P. Souteyrand; M. Bourges; C. Hermier



Subcutaneous cellulitis of the thigh due to grass awn migration in a German shepherd dog  

Microsoft Academic Search

Cellulitis is a severe, deep, suppurative infection that is poorly defined and tends to dissect through tissue planes. When\\u000a a foreign body enters the body, white blood cells attack the site and fight the invading agent. Sometimes, this collection\\u000a of blood cells forms a packed of pus or an abscess within the body’s tissues, organs, or confined spaces. Chronic sinus

A. S. Bigham; H. Nourani



Phalangeal fractures and metacarpophalangeal luxations subsequent to post-traumatic osteomyelitis and cellulitis in a dog.  


A working Border collie suffered a puncture wound to the metacarpal pad. No fractures or luxations were identified at initial presentation. Treatment was instigated with various antibacterials for a period of months. At subsequent visits, the dog's condition progressed with development of metacarpophalangeal joint luxation and phalangeal fractures secondary to cellulitis and chronic osteomyelitis. Amputation was curative. Prompt treatment of the acute condition with debridement and drainage may have prevented osteomyelitis becoming established in the first instance. PMID:15266860

Langley-Hobbs, S J; Lascelles, B D X



Insufficiency fractures of the distal tibia misdiagnosed as cellulitis in three patients with rheumatoid arthritis  

SciTech Connect

We describe 3 patients with rheumatoid arthritis who presented with diffuse pain, swelling, and erythema of the distal aspect of the lower extremity, suggestive of either cellulitis or thrombophlebitis, but were found to have insufficiency fractures of the distal tibia. The value of technetium-99m diphosphonate bone scintigraphy in the early recognition of these fractures and a possible explanation for the associated inflammatory symptoms are discussed.

Straaton, K.V.; Lopez-Mendez, A.; Alarcon, G.S. (Univ. of Alabama, Birmingham (USA))



Radiosensibilité comparative des cellules épithéliales de trachée de rats après irradiation alpha in vitro  

NASA Astrophysics Data System (ADS)

The main risk in nuclear industry is the internal contamination after inhalation of high LET alpha emitters radionuclides. Main targets of pulmonary carcinogenesis are epithelial respiratory tract cells. An in vitro study was performed in order to determine if a difference in the radiosensitivity occured in epithelial cells from the trachea of two rat strains: Sprague Dawley and Wistar Furth-Fischer F344 after alpha exposure. The cells were irradiated after sedimentation in a specific well. The irradiation was performed using 241Am electrodeposited sources. The irradiation dosecloning efficiency relation was evaluated. A kinetic study of the proliferation and the clonal growth has also been investigated. La contamination interne par inhalation de radionucléides émetteurs alpha de haut TEL est le risque majeur de l'industrie nucléaire. Les cibles principales de la cancérogenèse pulmonaire sont les cellules épithéliales de l'appareil respiratoire. Une étude in vitro a été menée pour déterminer s'il existe une différence de radiosensibilité aux rayonnement alpha, des cellules épithéliales trachéales de deux souches de rats : Sprague Dawley et Wistar Furth-Fischer F344. Les cellules sont irradiées sédimentées au fond d'un puit spécifique à l'aide de sources électrodéposées de 241Am. L'évaluation de la survie cellulaire en fonction de la dose d'irradiation est complétée par un suivi cinétique de la formation et de la prolifération des colonies.

Kugel, C.; Bailly-Despiney, I.; Lagroye, I.; Poncy, J. L.



Disseminated cryptococcosis initially presenting as cellulitis in a patient suffering from nephrotic syndrome  

PubMed Central

Background Cryptococcosis is considered as an opportunistic infection because it mainly occurs in immunosuppressed hosts. C. neoformans is usually acquired by the respiratory route and then may disseminate hematogenously to other places, such as meninges, bone and skin. Cutaneous involvement is a rare but important feature of disseminated cryptococcosis with a poor outcome if misdiagnosis. We reported the first case of patients with nephrotic syndrome suffering from disseminated cryptococcosis initially presented as cellulitis. Case presentation A 34-year-old man developed severe cellulitis on his both lower extremities without any preceding injury and allergies. The patient had been treated with systemic corticosteroids nearly one year for nephrotic syndrome. According to the outcome of blood culture, the wound area was interpreted as bacterial cellulitis at first. However, the antimicrobial treatment made no response and the skin biopsy revealed the presence of Cryptococcus neoformans, which was subsequently confirmed by microbiological culture. Though the initiation of therapy with fluconazole 400 mg per day was immediately adopted, the patient’s conditions suddenly plummeted and he died in the end. Conclusion Since the poor outcome of disseminated cryptococcosis if unrecognized and untreated in time, it should be investigated rigorously as a differential diagnosis in patients with nephrotic syndrome suffering from cutaneous diseases.



MR Imaging of Orbital Inflammatory Syndrome, Orbital Cellulitis, and Orbital Lymphoid Lesions: The Role of Diffusion-Weighted Imaging  

PubMed Central

BACKGROUND AND PURPOSE Orbital inflammatory syndrome (OIS) has clinical features that overlap with orbital lymphoid lesions and orbital cellulitis. Prompt diagnosis is needed in all 3 conditions because the management of each one differs greatly. CT and MR imaging, though useful, do not always distinguish among these conditions. The aim of this study was to identify the role of diffusion-weighted imaging (DWI) in differentiating these 3 diagnoses. MATERIALS AND METHODS A retrospective analysis of orbital MR imaging was conducted. T1- and T2-weighted and postcontrast images were analyzed. Region-of-interest analysis was performed by using measurements in areas of abnormality seen on conventional MR imaging sequences and measurements of the ipsilateral thalamus for each patient. The DWI signal intensity of the lesion was expressed as a percentage of average thalamic intensity in each patient. Similarly, lesion apparent diffusion coefficients (ADCs) and lesion-thalamus ADC ratios were calculated. Statistical significance was determined by the Kruskal-Wallis test, and post hoc pairwise comparisons, by the Mann-Whitney U test for DWI-intensity ratio, ADC, and ADC ratio. RESULTS A significant difference was noted in DWI intensities, ADC, and ADC ratio between OIS, orbital lymphoid lesions, and orbital cellulitis (P < .05). Lymphoid lesions were significantly brighter than OIS, and OIS lesions were significantly brighter than cellulitis. Lymphoid lesions showed lower ADC than OIS and cellulitis. A trend was seen toward lower ADC in OIS than in cellulitis (P = .17). CONCLUSIONS DWI may help differentiate OIS from lymphoid lesions and cellulitis and may allow more rapid management.

Kapur, R.; Sepahdari, A.R.; Mafee, M.F.; Putterman, A.M.; Aakalu, V.; Wendel, L.J.A.; Setabutr, P.



Dermatitis and lymphadenitis resembling juvenile cellulitis in a four-year-old dog.  


A four-year-old, entire male toy poodle was presented with a two-and-a-half-week history of ocular discharge progressing to periorbital alopecia, depigmentation, alopecia and ulceration around the muzzle. There was also a haemorrhagic discharge from the ears, pyrexia, lethargy and generalised lymphadenopathy. The clinical, cytological, bacteriological and histopathological findings were consistent with a diagnosis of dermatitis resembling juvenile cellulitis in an adult dog. Glucocorticoid therapy led to rapid resolution of the clinical signs and the dog has remained in remission for two years after cessation of treatment. PMID:15163053

Neuber, A E; van den Broek, A H M; Brownstein, D; Thoday, K L; Hill, P B



Dissecting Cellulitis of the Scalp Responding to Intravenous Tumor Necrosis Factor-alpha Antagonist  

PubMed Central

The authors present the case of a 30-year-old male patient with a severe and long-standing dissecting cellulitis of the scalp. The disease did not respond to conventional treatment, including oral antibiotics, isotretinoin, and prednisolone. Quality of life was significantly impaired. After introduction of anti-tumor necrosis factor-alpha treatment (infliximab), the malodorous discharge stopped, inflammation was reduced significantly, nodules became flat, and pain decreased. The treatment was well tolerated although he developed a temporary psoriasiform rash after the second intravenous infusion. In conclusion, anti-tumor necrosis factor-alpha treatment is a new therapeutic option in this severe and recalcitrant disorder.

Wollina, Uwe; Gemmeke, Astrid; Koch, Andre



Cellulitis and myositis caused by Agrobacterium radiobacter and Haemophilus parainfluenzae after influenza virus vaccination.  


Agrobacterium radiobacter is a gram-negative aerobic bacillus that has been reported as a cause of disease only 36 times in the literature. More than half of the patients (25) have had bacteremia. Peritonitis, urinary tract infection, endocarditis, and one case of cellulitis associated with bacteremia have also been reported. Infection is often associated with immunosuppression and the presence of a plastic foreign body, such as central venous catheters, nephrostomy tubes, intraperitoneal catheters, and prosthetic cardiac valves. We present apparently the first case of A radiobacter causing myositis after influenza virus vaccination. PMID:9225903

Owensby, J E; Elliott, S; Tu, K; Hernandez, J E



Emphysematous cellulitis of the left thigh caused by sigmoid diverticulum perforation.  


Necrotizing fasciitis and gas gangrene of the lower extremities are two life-threating emergencies and are the most common causes of gas presence in the lower extremity. Rarely the gas presence is secondary to a perforated viscus and especially the colon. Large bowel diverticula are a quiet common disease in western countries and their prevalence increases with age. Also, the possibility of complications is greater in older patients. However, perforated colonic diverticulum seldom presents only with the presence of gas in the lower extremity. We report a case of emphysematous cellulitis of the left thigh caused by a sigmoid diverticulum perforation in a patient with peritoneal carcinomatosis. PMID:21780564

Ioannidis, Orestis; Kakoutis, Emmanouil; Paraskevas, George; Chatzopoulos, Stavros; Kotronis, Anastasios; Papadimitriou, Nikolaos; Konstantara, Athina; Makrantonakis, Apostolos


Fluconazole-resistant Kodamaea ohmeri fungemia associated with cellulitis: case report and review of the literature.  


Kodamaea (Pichia) ohmeri was formerly considered a contaminant, but is now known to be a significant human pathogen that has been shown to cause fungemia, endocarditis, funguria, and peritonitis in immunocompromised patients. We report a case of fungemia caused by K. ohmeri in a 71-year-old man with cellulitis. The patient was sent to the emergency room due to leg edema, fever, and change of consciousness. During hospitalization, a series of examinations including blood cultures were performed. On hospital day 8, blood culture yielded a yeast colony. Fluconazole was given empirically, but had no effect. The pathogen was identified as K. ohmeri by Vitek YBC card, API 20C, sequencing of the 18S rRNA gene, and the D1/D2 domains of the 26S rRNA gene and the internally transcribed spacer (ITS) regions. Antifungal susceptibility testing was performed with the ATB-Fungus system, and a high minimum inhibitory concentration (level up to 64 mg/l) for fluconazole was found. Fluconazole was replaced with amphotericin B deoxylate, and the fever and cellulitis inflammation gradually subsided. The patient was discharged in a stable condition. This is the first case of K. ohmeri fungemia in Taiwan. PMID:19411182

Yang, Bing-Heng; Peng, Ming-Yieh; Hou, Shu-Jin; Sun, Jun-Ren; Lee, Shih-Yi; Lu, Jang-Jih



Sinonasal melioidosis in a returned traveller presenting with nasal cellulitis and sinusitis.  


We illustrate a case involving a 51-year-old man who presented to a tertiary hospital with sepsis secondary to an abscess of the nasal vestibule and pustular eruptions of the nasal mucosa. Associated cellulitis extended across the face to the eye, and mucosal thickening of the sinuses was seen on computed tomography. The patient underwent incision and drainage and endoscopic sinus surgery. Blood cultures and swabs were positive for a gram-negative bacillus, Burkholderia pseudomallei. He had multiple risk factors including travel to an endemic area. The patient received extended antibiotic therapy in keeping with published national guidelines. Melioidosis is caused by Burkholderia pseudomallei, found in the soil in Northern Australia and Asia. It is transmitted via cutaneous or inhaled routes, leading to pneumonia, skin or soft tissue abscesses, and genitourinary infections. Risk factors include diabetes, chronic lung disease, and alcohol abuse. It can exist as a latent, active, or reactivated infection. A high mortality rate has been identified in patients with sepsis. Melioidosis is endemic in tropical Northern Australia and northeastern Thailand where it is the most common cause of severe community-acquired sepsis. There is one other report of melioidosis in the literature involving orbital cellulitis and sinusitis. PMID:23936707

Lim, Rebecca Sin Mei; Flatman, Sam; Dahm, Markus C



Oral Linezolid as Alternative Therapy in Patients with Cellulitis Who Have Been Referred to an Infusion Center  

Microsoft Academic Search

Ten patients with moderately severe cellulitis who were referred to a hospital infusion center for parenteral antibiotic therapy were given oral linezolid instead. All of the patients complied with the treatment regimen and exhibited a clinical cure of their infection. Adverse drug events were mild, and none of the patients discontinued therapy prematurely. The total cost associated with an average

Gary E. Stein; Sharon Schooley; Vivek Kak; Daniel H. Havlichek


Cemento-ossifying Fibroma Of Paranasal Sinus Presenting Acutely As Orbital Cellulitis  

PubMed Central

Fibro-osseous lesions of the face and paranasal sinuses are relatively uncommon. These lesions have overlapping clinical, radiologic and pathologic features causing difficulty in diagnosis. Neoplastic fibro-osseous paranasal sinus lesions can be benign or malignant. The benign fibro-osseous lesions described are: ossifying fibroma (and its histologic variants) and fibrous dysplasia. The variants of ossifying fibroma differ in the nature of calcified material (i.e. cementum versus bone), in the location of the lesion (oral versus paranasal sinus or orbital), other morphologic variations (presence of psammomatoid concretions) and biologic behavior (aggressive versus stable). Presence of cementum or bone classifies the lesion as cementifying fibroma or ossifying fibroma respectively while lesions with mixture of both cementum and bone are called cemento-ossifying fibroma. We describe a case of a young adult male with cemento-ossifying fibroma of paranasal sinus presenting acutely as left orbital cellulitis with proptosis.

Khanna, Maneesh; Buddhavarapu, Shanker Rao; Hussain, Sheik Akbar; Amir, Emran



Dermatitis and cellulitis in leopard geckos (Eublepharis macularius) caused by the Chrysosporium anamorph of Nannizziopsis vriesii.  


An epizootic of ulcerative to nodular ventral dermatitis was observed in a large breeding colony of 8-month to 5-year-old leopard geckos (Eublepharis macularius) of both sexes. Two representative mature male geckos were euthanized for diagnostic necropsy. The Chrysosporium anamorph of Nannizziopsis vriesii (CANV) was isolated from the skin lesions, and identification was confirmed by sequencing of the internal transcribed spacer region of the rRNA gene. Histopathology revealed multifocal to coalescing dermal and subcutaneous heterophilic granulomas that contained septate fungal hyphae. There was also multifocal epidermal hyperplasia with hyperkeratosis, and similar hyphae were present within the stratum corneum, occasionally with terminal chains of arthroconidia consistent with the CANV. In one case, there was focal extension of granulomatous inflammation into the underlying masseter muscle. This is the first report of dermatitis and cellulitis due to the CANV in leopard geckos. PMID:23160542

Toplon, D E; Terrell, S P; Sigler, L; Jacobson, E R



Wound botulism associated with black tar heroin and lower extremity cellulitis.  


Wound botulism is a rare and potentially fatal disease. The use of black tar heroin has spawned an increase in the incidence of the disease, with the majority of cases occurring in California. The use of botulism antitoxin and surgical debridement are recommended to decrease hospital stay. For this to be effective, the diagnosis of wound botulism first must be considered, followed by an aggressive search for any area of infection that may be debrided. This case report demonstrates several factors to consider in patients presenting with symptoms of botulism poisoning: occurrence away from the Mexico border, no obvious abscess, and the need for prolonged ventilatory support. This case report documents a prolonged hospital stay, possibly caused by delay in administration of antitoxin in a patient with cellulitis that was not considered appropriate for debridement. PMID:11348817

Mitchell, P A; Pons, P T



Effets du décocté de Biophytum petersianum (Oxalidaceae) sur la libération du calcium du réticulum sarcoplasmique des cellules musculaires squelettiques  

Microsoft Academic Search

Résumé  Le décocté de la plante entière de Biophytum petersianum (Oxalidaceae) est utilisé dans la médecine traditionnelle au Togo pour traiter l’hypertension artérielle. Le présent travail\\u000a évalue les effets du décocté de la plante entière de Biophytum petersianum sur la libération du calcium stocké dans le réticulum sarcoplasmique des cellules musculaires squelettiques. Les résultats\\u000a ont montré qu’en présence du décocté, la

A. P. Mouzou; S. Titrikou; B. Constantin; S. Sebille; C. Cognard; M. Gbeassor; G. Raymond



A case of cellulitis of the hands caused by a predatory bird attack.  


Many species have been drastically affected by rapid urbanization. Harris's hawks from their natural habitat of open spaces and a supply of rodents, lizards and other small prey have been forced to change their natural environment adapting to living in open spaces in sub- and peri-urban areas. Specific areas include playgrounds, parks and school courtyards. The migration of this predatory species into these areas poses a risk to individuals, and especially the children are often attacked by claws, talons and beaks intentionally or as collateral damage while attacking rodent prey. In addition, the diverse micro-organisms harbored in the beaks and talons can result in wound infections, presenting a challenge to clinical management. Here we would like to present a case of an 80-year-old man with cellulitis of both hands after sustaining minor injuries from the talons of a Harris's hawk and review the management options. We would also like to draw attention to the matter that, even though previously a rarity, more cases of injuries caused by birds of prey may be seen in hospital settings. PMID:23569751

Khan, M Adil Abbas; Farid, Mohammed; Sobani, Zain A; Ali, Syed Nadir; Malick, Huzaifa; Baqir, Maryam; Sharif, Hasanat; Beg, M Asim



Peritonsillar abscess and cellulitis and their relation to a positive antigen detection test for streptococcal infection.  


The microbiological cause of peritonsillar abscess and the role of group A ?-haemolytic Streptococcus (GAS) are unclear. We performed a retrospective study at the ear, nose and throat clinic (ENT) of Orebro University Hospital, Sweden, and included 376 events of peritonsillitis between 2002 and 2004. We determined if the patients had visited a primary healthcare centre (PHCC) within 30 days prior to inclusion. The results of the rapid antigen detection test for GAS (Strep A) taken at the PHCC were compared with the occurrence of peritonsillar abscess (PTA) and peritonsillar cellulitis (PTC). A Strep A test was performed in 61% (229/376) of the events studied. Strep A was positive in 22% of PTA events and in 35% of PTC events (p = 0.036). Of 48,000 Strep A tests taken in primary healthcare, mainly for sore throat, 22% were positive. We examined the relationship between age, the incidence of PTA, and positive Strep A tests. We also determined if there was a monthly correlation between number of positive Strep A tests and number of PTA events. We found no significant correlations. In conclusion, our findings indicate that GAS does not play a major role in the development of PTA/PTC. PMID:20515290

Risberg, Stefan; Engfeldt, Peter; Hugosson, Svante



Facial Candida albicans cellulitis occurring in a patient with oral submucous fibrosis and unknown diabetes mellitus after local corticosteroid injection treatment.  


Facial cellulitis caused by odontogenic bacterial infection is frequently encountered; however, facial cellulitis caused by Candida albicans infection is rarely found. A patient with oral submucous fibrosis (OSF) and unknown diabetes mellitus (DM) was treated in our out-patient dental clinic by biweekly submucosal injection of 40 mg triamcinolone acetonide into bilateral buccal mucosae plus forced mouth opening performed by the two hands of the clinician. The interincisal distance of the patient improved from 28 to 48 mm after four times of steroid injection. The symptoms and signs of OSF also improved markedly. Unfortunately, facial candidal cellulitis occurred 2 months after the last time of steroid injection treatment. The infection was cured by incision and drainage, intravenous administration of amphotericin B (100 mg once a day for a week), and an appropriate medical control of DM. No recurrence of facial cellulitis was found during the follow-up period of 18 months. To prevent the occurrence of facial cellulitis after a high-dose steroid therapy, some prophylactic procedures should be taken before the initiation of the steroid treatment. PMID:15061713

Chen, Hsin-Ming; Shih, Chiang-Ching; Yen, K Lawrence; Wang, Sheng-Ming; Kuo, Ying-Shiung; Kuo, Mark Yen-Ping; Chiang, Chun-Pin



Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg: results of the U.K. Dermatology Clinical Trials Network's PATCH II trial  

PubMed Central

Summary Background Cellulitis (erysipelas) of the leg is a common, painful infection of the skin and underlying tissue. Repeat episodes are frequent, cause significant morbidity and result in high health service costs. Objectives To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes. Methods Double-blind, randomized controlled trial including patients recently treated for an episode of leg cellulitis. Recruitment took place in 20 hospitals. Randomization was by computer-generated code, and treatments allocated by post from a central pharmacy. Participants were enrolled for a maximum of 3 years and received their randomized treatment for the first 6 months of this period. Results Participants (n = 123) were randomized (31% of target due to slow recruitment). The majority (79%) had suffered one episode of cellulitis on entry into the study. The primary outcome of time to recurrence of cellulitis included all randomized participants and was blinded to treatment allocation. The hazard ratio (HR) showed that treatment with penicillin reduced the risk of recurrence by 47% [HR 0·53, 95% confidence interval (CI) 0·26–1·07, P = 0·08]. In the penicillin V group 12/60 (20%) had a repeat episode compared with 21/63 (33%) in the placebo group. This equates to a number needed to treat (NNT) of eight participants in order to prevent one repeat episode of cellulitis [95% CI NNT(harm) 48 to ? to NNT(benefit) 3]. We found no difference between the two groups in the number of participants with oedema, ulceration or related adverse events. Conclusions Although this trial was limited by slow recruitment, and the result failed to achieve statistical significance, it provides the best evidence available to date for the prevention of recurrence of this debilitating condition.



Les cellules de la lignée germinale humaine ont la capacité d'internaliser la sex steroid-binding protein humaine (SBPh): Etude par autohistoradiographie en microscopie électronique à transmission (MET)  

Microsoft Academic Search

Resume  Il a été récemment démontré que les cellules spermatogénétiques de rat sont capables de lier et d'internaliser spécifiquement\\u000a l'androgen-binding protein de rat (ABPr). De même les cellules spermatogénétiques du macaque, sont capables de lier et d'internaliser\\u000a spécifiquement la sex steroid-binding protein humaine (SBPh).\\u000a \\u000a Cette étude consiste à tester si des interactions entre les cellules spermatogénétiques et les protéines de liaison

R. Bedjou; A. Gerard; F. Felden; P. Franck; Th Durriez; J. Hubert; H. Lejeune; J. L. Gueant; H. Gerard



Oral flucloxacillin and phenoxymethylpenicillin versus flucloxacillin alone for the emergency department outpatient treatment of cellulitis: study protocol for a randomised controlled trial  

PubMed Central

Background Oral flucloxacillin, either alone or in combination with phenoxymethylpenicillin, is a commonly prescribed antibiotic for the treatment of cellulitis, particularly in Ireland and the United Kingdom. This study aims to establish the non-inferiority of oral monotherapy (flucloxacillin alone) to dual therapy (flucloxacillin and phenoxymethylpenicillin) for the outpatient treatment of cellulitis in adults. Methods/design This study is a multicentre, randomised, double-blind, placebo-controlled trial of adults who present to the emergency department (ED) with cellulitis that is deemed treatable on an outpatient basis with oral antibiotics. After fulfilling specified inclusion and exclusion criteria, informed consent will be taken. Patients will be given a treatment pack containing 7 days of treatment with flucloxacillin 500 mg four times daily and placebo or flucloxacillin 500 mg four times daily and phenoxymethylpenicillin 500 mg four times daily. The primary outcome measure under study is the proportion of patients in each group in which there is greater than or equal to a 50% reduction in the area of diameter of infection from the area measured at enrolment at the end-of-treatment visit (7 to 10 days). Secondary endpoints include a health-related quality of life measurement as rated by the SF-36 score and the Extremity Soft Tissue Infection Score (not validated), compliance and adverse events. Patients will be followed up by telephone call at 3 days, end-of-treatment visit (EOT) at 7 to 10 days and test-of-cure (TOC) visit at 30 days. To achieve 90% power, a sample size of 172 patients per treatment arm is needed. This assumes a treatment success rate of 85% with oral flucloxacillin and phenoxymethylpenicillin, an equivalence threshold ? = 12.5% and an ? = 0.025. Non-inferiority will be assessed using a one-sided confidence interval on the difference of proportions between the two groups. Standard analysis including per-protocol and intention-to-treat will be performed. Discussion This trial aims to establish the non-inferiority of flucloxacillin monotherapy to dual therapy in the treatment of uncomplicated cellulitis among ED patients. In doing so, this trial will bridge a knowledge gap in this understudied and common condition and will be relevant to clinicians across several different disciplines. Trial registration EudraCT Number 2008-006151-42



Flame figures associated with eosinophilic dermatosis of hematologic malignancy: is it possible to distinguish the condition from eosinophilic cellulitis in patients with hematoproliferative disease?  


Eosinophilic dermatosis of hematologic malignancy is a multifaceted dermatosis with a wide morphological spectrum, presenting as pruritic, erythematous, papular and occasionally vesicular, urticarial, nodular eruptions. Histopathologically eosinophil infiltration in the super and deep dermis was found. We reported a case of eosinophilic dermatosis of hematologic malignancy presented as urticarial and vesicular lesions in a patient with chronic lymphocytic leukemia. A skin biopsy revealed a prominent subepidermal blister and a diffuse infiltrate of eosinophils with flame figures in the dermis and subcutaneous tissue. Although flame figures associated with eosinophilic dermatosis of hematologic malignancy is rarely reported, we believe that it would not seem unusual to find them in this skin disease. Eosinophilic cellulitis, which share clinical and histological features with eosinophilic dermatosis of hematologic malignancy, has also been described as showing an association with hematoproliferative diseases. In order to clearly describe eosinophilic dermatosis in patients with hematologic malignancies, the terminology eosinophilic dermatosis of hematologic malignancy, instead of eosinophilic cellulitis, would be a more suitable term in patients with eosinophilic dermatosis. PMID:23923089

Qiao, Jianjun; Sun, Chang-E; Zhu, Weifang; Zhu, Dingxian; Fang, Hong



[Severe diffuse facial cellulitis].  


Twenty cases of severe cervicofacial infections among 184 cases of cellulites treated in 1991 and 1992 at the Lille University Hospital were investigated. Outcome was compared with results reported in the literature. Outcomes were similar and emphasized the critical nature of this type of infection which caused 7 deaths in our series and severe anatomic and functional sequelae. All patients (n = 20) were given anti-inflammatory drugs prior to surgery. The correlation between disease severity and use of anti-inflammatory drugs would appear to be an established fact. Criteria predicting severity were identified in order to obtain a score for high or low risk and to better adapt the medical and surgical management strategy. PMID:9411704

Rose, C; Tellion, C; Ferri, F; Donazzan, M



What Is Cellulitis?  


... Academy of Ophthalmology medical disclaimer privacy policy sponsorship & advertising policies about us For Medical Providers EyeWiki contact us sitemap Reproducing text or images from this website is strictly prohibited by US and international copyright law. You may link from your website to any ...


Campylobacter fetus infection presenting with bacteremia and cellulitis in a 72-year-old man with an implanted pacemaker: a case report  

PubMed Central

Introduction Campylobacter is an important causative agent of intestinal infections in humans. Bacteremia is detected in less than 1% of patients, mainly in immunocompromised patients and in extreme age groups. Cellulitis is a relatively common manifestation of Campylobacter infection, but concomitant bacteremia is a rare event. Infections of the pacemaker area are caused primarily by staphylococci, followed by fungi, streptococci and Gram-negative rods. To the best of our knowledge, this is the first case report of pacemaker pocket infection and bacteremia caused by Campylobacter fetus. Case presentation A 72-year-old Croatian Caucasian man with myelodysplasia, impaired fasting glucose levels and a recently implanted permanent pacemaker was admitted to hospital after six days of fever, development of red swelling of the pacemaker pocket area and worsening of his general condition. No antibiotic therapy was introduced in the outpatient setting. He denied any recent gastrointestinal disturbances. With the exception of an elevated leukocyte count, erythrocyte sedimentation rate, and C-reactive protein and blood glucose levels, other laboratory findings were normal. Treatment with vancomycin plus netilmicin was introduced, and a surgical incision with drainage of the pacemaker pocket was performed. The entire pacemaker system was removed and a new one re-implanted after 14 days of antibiotic therapy. Transesophageal echocardiography showed no pathological findings. Three subsequent blood cultures obtained on admission as well as swab culture of the incised pacemaker area revealed Campylobacter fetus; stool and pacemaker lead cultures were negative. According to the microbiological results, antibiotic therapy was changed to ciprofloxacin plus netilmicin. A clinical examination and the results of a laboratory analysis performed after two weeks of therapy were within normal limits. Conclusion Myelodysplasia, impaired fasting glucose levels and older age could be contributing factors for the development of bacteremic Campylobacter fetus cellulitis. Emergent surgical and antibiotic treatment are mandatory and provide the optimal outcome for such types of pacemaker pocket infection.



Effect of Chicken Anemia and Infectious Bursal Disease Vaccines and Marek's Disease Virus on the Development of Cellulitis and Myositis Lesions in Floor-Reared MHC-Defined Broiler Chickens  

Microsoft Academic Search

Wang, C., Norton, R.A., Macklin, K.S. and Krehling, J.T. 2005. Effect of chicken anemia and infectious bursal disease vaccines and Marek's disease virus on the development of cellulitis and myositis lesions in floor-reared MHC-defined broiler chickens. J. Appl. Anim. Res., 27: 1–5.In this experiment, 414 chickens were reared in a house in which the previous flock had experienced Marek's disease.

Chengming Wang; Robert A. Norton; Kenneth S. Macklin; James T. Krehling



Cellule enterocromaffini e cellule basigranulose acidofile nei Vertebrati  

Microsoft Academic Search

\\u000a Zusaammenfassung  \\u000a \\u000a \\u000a \\u000a 1. \\u000a \\u000a Die enterochromaffinen Zellen kommen in der ganzen Wirbeltierreihe vor, mit Ausnahme der Cyclostomen und der Teleostier. Die\\u000a Krnchen dieser Zellen geben bei allen erforschten Arten einen positiven Ausfall der Chrom-Silber- und Diazoreaktion.\\u000a \\u000a \\u000a \\u000a \\u000a 2. \\u000a \\u000a Aus solchen Ergebnissen kann man den Schlu ziehen, da in den Granula immer eine gleiche Substanz vorhanden ist, die wir,\\u000a mitLison undClara, als Ortho-diphenol ansehen

Maffo Vialli; Vittorio Erspamer



Cellulitis Infection: Is It Contagious?  


... References Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practic. 7th ed. Philadelphia, Pa.: Mosby ... conditions of use policy (Updated July 13, 2013) LEGAL CONDITIONS AND TERMS OF USE APPLICABLE TO ALL ...


Septicaemia secondary to Vibrio vulnifi cus cellulitis  

Microsoft Academic Search

Vibrio vulnifi cus is a naturally occurring, salt-water bacteria found in estuarine and coastal waters worldwide. It prefers low salinity and warm water temperatures for optimum growth. Infection from Vibrio vulnifi cus is uncommon, although it has been reported from many locations (e.g. southern United States of America, Israel, Republic of Korea, Japan, Taiwan, Spain, Turkey). It can be serious

Peter R Lewis; Lucy Cook; Janet Drewitt-Smith; Adam D McEwen; Linda V Granger


Chromobacterium violaceum cellulitis and sepsis following cutaneous marine trauma.  


Chromobacterium violaceum is a gram-negative bacillary organism that characteristically produces the purple pigment violacein. Documented as the cause of clinically relevant human infections in only 35 cases in the United States, C violaceum is particularly seen in patients with a history of cutaneous injury or trauma. We report the case of an 18-year-old woman who was struck by a propeller in a boating accident and sustained multiple deep lacerations of her right lower extremity. Shortly after admission to the hospital, the patient became frebrile and developed leukocytosis. Bacterial cultures revealed C violaceum, which demonstrated a characteristic purple pigment production on blood agar. Antimicrobial therapy was initiated, but 2 days after admission, the skin and subcutaneous tissue surrounding the patient's wounds became necrotic, necessitating an above-the-knee amputation of the right lower extremity (transfemoral amputation). The patient's condition improved after continued antimicrobial therapy and she was subsequently discharged in good health. This case represents a successful outcome of a rare but frequently fatal infection due to a morphologically and geographically distinct human pathogen. PMID:18441852

Carter, Elliot; Cain, Kressida; Rutland, Beth



Réglementation de la FDA sur les cellules et tissus humains  

Center for Biologics Evaluation and Research (CBER)

Text Version... appliquant ainsi une approche étagée et basée sur le risque, il est possible d'éviter une manipulation ou une transformation impropre susceptible ... More results from


Ciprofloxacin-resistant Aeromonas hydrophila cellulitis following leech therapy.  


We report a case of surgical site infection with ciprofloxacin-resistant Aeromonas hydrophila following leech therapy. Antimicrobial and genetic analyses of leech and patient isolates demonstrated that the resistant isolates originated from the leech gut microbiota. These data suggest that ciprofloxacin monotherapy as a prophylaxis regimen prior to leech therapy may not be effective in preventing infection. PMID:23363826

Giltner, Carmen L; Bobenchik, April M; Uslan, Daniel Z; Deville, Jaime G; Humphries, Romney M



I fenomeni cromosomici Delle cellule germinali in Artemia salina leach  

Microsoft Academic Search

Conclusioni relative ad Artemia salina Leach:1.Le artemie diploidi e poliploidi (tetraploidi) non differiscono tra loro per la forma dei cromosomi, ma solo per il loro numero.2.Le artemie poliploidi partenogenetiche comuni (per es. delle saline di Portorose) maturano le uova senza sinapsi (come appare dal confronte con l'oogenesi e la spermatogenesi delle artemie anfigoniche), ma con fenomeni cromosomici che ricordano la

Claudio Barigozzi; CLAUDIO BARICOZZI



Necrotising fasciitis and cellulitis after traditional Samoan tattooing: case reports  

Microsoft Academic Search

Traditional Samoan tattooing, ta tatau, is a vital part of Samoan culture. It is being performed with greater frequency on New Zealand resident Samoans. Unfortunately, ta tatau has recently been the causal factor in two significant infectious cases, in one of which death resulted. The two cases were clinically reviewed. An investigation into the history and practice of ta tatau

Christopher J. W. Porter; Jeremy W. Simcock; Craig A. MacKinnon



Les cellules gonadotropes de l'hypophyse chez le Porc  

Microsoft Academic Search

The present paper concerns the identification of LH -and FSH-secreting cells in the hypophysis of the pig. The morphological characteristics of the involved cell types can be accurately demonstrated by two staining techniques: PAS-methazol: blue-Orange G and PAS-Alcian blue-Orange G. Only the second of these methods reveals that the large cells of the median region, usually considered as FSH-secretory, can

Marc Herlant; Francis Ectors



Ciprofloxacin-Resistant Aeromonas hydrophila Cellulitis following Leech Therapy  

PubMed Central

We report a case of surgical site infection with ciprofloxacin-resistant Aeromonas hydrophila following leech therapy. Antimicrobial and genetic analyses of leech and patient isolates demonstrated that the resistant isolates originated from the leech gut microbiota. These data suggest that ciprofloxacin monotherapy as a prophylaxis regimen prior to leech therapy may not be effective in preventing infection.

Giltner, Carmen L.; Bobenchik, April M.; Uslan, Daniel Z.; Deville, Jaime G.



Analyse des échanges de chromatides dans les cellules somatiques humaines  

Microsoft Academic Search

A new technique (BUdR treatment followed by acridine orange staining) allowing a differentiation of sister chromatids is described. A statistical analysis of 91 human karyotypes gives an estimate of the frequency of exchanges. The mean of sister chromatid exchanges is 27,3 and the minimum number is 11 per cell. — The frequency of these exchanges is proportional to the relative

B. Dutrillaux; A. M. Fosse; M. Prieur; J. Lejeune



Cellulitis related to bioabsorbable plate and screws in infraorbital rim fracture.  


An absorbable plating system is most commonly used to fix the bones in craniomaxillofacial surgery. Many studies focused on the advantages and clinical utility of absorbable plate and screws, but there are no reports on the complications related to these devices. From March 2004 to March 2009, 430 patients with facial bone fractures including infraorbital rim fractures underwent craniomaxillofacial surgery, in which rigid fixation was achieved with an absorbable plate and screws (Stryker, Freiburg, Germany). Five men with a delayed inflammatory reaction and infection at infraorbital rim fracture site were reviewed. Their mean age was 39 (range, 18-53 y), and all patients had maxillary sinusitis. The period from surgery to the onset of symptoms ranged from 3 to 10 weeks with a mean of 5 weeks. One patient was managed with oral antibiotics, but the other 4 patients required incisional drainage with the removal of the plate and screws because of abscess formation. The patients' symptom improved after removing the absorbable plate and screws and saline irrigation, and there was no recurrence of infection during the 12-month follow-up period. When fixing infraorbital fractures, particularly in patients with sinusitis, it is recommended to use short screws to prevent penetration of the maxillary sinus wall. In particular, one should pay attention and use shorter screws owing to the thinness of the medial infraorbital rim. PMID:21403541

Kwon, Ho; Kim, Sang-Wha; Jung, Sung-No; Sohn, Won-Il; Moon, Suk-Ho



Shellfish-acquired Vibrio cholerae cellulitis and sepsis from a vulnerable leg.  


The following case concerns a soft tissue Vibrio cholerae (V. cholerae) infection in a fisherman who cut his foot while retrieving his fishing dinghy. It is rare for V. cholerae to cause extraintestinal infection. This V. cholera was identified as a non-toxigenic organism. The patient was successfully treated with medical therapy at Waikato Hospital (Hamilton, New Zealand) and discharged home after 10 days. PMID:24045356

Whittaker, Samuel J



Recherches au microscope electronique sur les cellules parietales alveolaires du poumon des mammiferes  

Microsoft Academic Search

Nous ne méconnaissons pas le caractère encore hypothétique de ces considérations générales. Nous les croyons cependant utiles, car elles permettent de rattacher certaines constatations cellulaires à un ensemble plus vaste de modifications tissulaires dont elles représentent seulement un élément.

A. Policard; A. Collet; S. Pregermain



Pemetrexed-induced cellulitis: a rare toxicity in non-small cell lung cancer treatment.  


Pemetrexed is indicated for locally advanced or metastatic non-squamous non-small-cell lung cancer as an initial treatment in combination with cisplatin or after prior chemotherapy as a single agent. It is generally a well-tolerated drug. The most common adverse reactions (incidence ? 20%) with single-agent use are fatigue, nausea, and anorexia. Additional common side effects when used in combination with cisplatin include vomiting, neutropenia, leukopenia, anemia, stomatitis/pharyngitis, thrombocytopenia, and constipation. Peripheral edema with associated erythema has rarely been described as an adverse effect. Herein, we report a patient with advanced non-small-cell lung cancer who experienced bilateral peripheral edema after pemetrexed administration. Discontinuation of pemetrexed and corticosteroids use completely resolved peripheral edema. PMID:22357637

Katsenos, Stamatis; Psara, Anthoula; Panagou, Chara



Caracterisation des proprietes acoustiques des materiaux poreux a cellules ouvertes et a matrice rigide ou souple  

NASA Astrophysics Data System (ADS)

L'objectif global vise par les travaux de cette these est d'ameliorer la caracterisation des proprietes macroscopiques des materiaux poreux a structure rigide ou souple par des approches inverses et indirectes basees sur des mesures acoustiques faites en tube d'impedance. La precision des approches inverses et indirectes utilisees aujourd'hui est principalement limitee par la qualite des mesures acoustiques obtenues en tube d'impedance. En consequence, cette these se penche sur quatre problemes qui aideront a l'atteinte de l'objectif global precite. Le premier probleme porte sur une caracterisation precise de la porosite ouverte des materiaux poreux. Cette propriete en est une de passage permettant de lier la mesure des proprietes dynamiques acoustiques d'un materiau poreux aux proprietes effectives de sa phase fluide decrite par les modeles semi-phenomenologiques. Le deuxieme probleme traite de l'hypothese de symetrie des materiaux poreux selon leur epaisseur ou un index et un critere sont proposes pour quantifier l'asymetrie d'un materiau. Cette hypothese est souvent source d'imprecision des methodes de caracterisation inverses et indirectes en tube d'impedance. Le critere d'asymetrie propose permet ainsi de s'assurer de l'applicabilite et de la precision de ces methodes pour un materiau donne. Le troisieme probleme vise a mieux comprendre le probleme de transmission sonore en tube d'impedance en presentant pour la premiere fois un developpement exact du probleme par decomposition d'ondes. Ce developpement permet d'etablir clairement les limites des nombreuses methodes existantes basees sur des tubes de transmission a 2, 3 ou 4 microphones. La meilleure comprehension de ce probleme de transmission est importante puisque c'est par ce type de mesures que des methodes permettent d'extraire successivement la matrice de transfert d'un materiau poreux et ses proprietes dynamiques intrinseques comme son impedance caracteristique et son nombre d'onde complexe. Enfin, le quatrieme probleme porte sur le developpement d'une nouvelle methode de transmission exacte a 3 microphones applicable a des materiaux ou systemes symetriques ou non. Dans le cas symetrique, on montre que cette approche permet une nette amelioration de la caracterisation des proprietes dynamiques intrinseques d'un materiau. Mots cles. materiaux poreux, tube d'impedance, transmission sonore, absorption sonore, impedance acoustique, symetrie, porosite, matrice de transfert.

Salissou, Yacoubou


Efficacy of Oral ?-Lactam versus Non-?-Lactam Treatment of Uncomplicated Cellulitis  

Microsoft Academic Search

BackgroundPreferred therapy for purulent skin and soft tissue infections is incision and drainage, but many infections cannot be drained. Empiric therapies for these infections are ill-defined in the era of community-acquired methicillin-resistant Staphylococcus aureus.

Karl J. Madaras-Kelly; Richard E. Remington; Catherine M. Oliphant; Kevin L. Sloan; David T. Bearden



Une gammapathie monoclonale associée à un lymphome colique primitif à cellules du manteau  

Microsoft Academic Search

The association of a monoclonal gammopathy (MG) with a B cell non-Hodgkin's lymphoma (NHL) is a well-known phenomenon. It has been recognized in many subtypes of primary gastrointestinal lymphoma but its association with primary colonic mantle cell lymphoma has never been yet described. We report a 65-year-old man who presented with an exudative ascites and constipation. Serum electrophoresis showed a

G. Mohamed; A. Kochlef; D. Gargouri; A. Kilani; H. Elloumi; A. Ouakaa; N. Belhadj; M. Romani; J. Kharrat; A. Ghorbel



Osservazioni Sulle Infrastrutture di Anabaena Cycadinae E delle Cellule dei Tubercoli Radicali di Cycas Revoluta  

Microsoft Academic Search

Observations on the infrastructures of ANABAENA CYCADINAE and of root-nodules cells of CYCAS REVOLUTA. — Light and electron microscope observations carried on the fine and ultrafine sections of root-nodules of Cycas revoluta, brought in evidence differences structural and infrastructural of cells. These differences concern mainly the modifications presented by reticulum endoplasmic which in middle-aged cells takes a fragmentary and vescicular

Maria Grilli



On cellulation and banding during crystallization of a linear-low-density polyethylene from linear nuclei  

Microsoft Academic Search

Linear-low-density polyethylene shows novel features, in addition to those found for the linear polymer, when crystallized as row structures from linear nuclei. There is the same division between disordered and ordered (inclined) fold surfaces for faster and slower crystallization, respectively, with the changeover occurring at a lower temperature and for a longer time than the linear polymer. The first new

M. I Abo el Maaty; D. C Bassett



Cancers bronchiques non à petites cellules : amélioration des chances de survie par la radiothérapie conformationnelle ?  

Microsoft Academic Search

The conformal radiotherapy approach, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), is based on modern imaging modalities, efficient 3D treatment planning systems, sophisticated immobilization devices and demanding quality assurance and treatment verification. The main goal of conformal radiotherapy is to ensure a high dose distribution tailored to the limits of the target volume while reducing exposure of healthy tissues.

P Giraud; S Helfre; A Lavole; J. C Rosenwald; J. M Cosset



Coexistence of dermal sinus tract, dermoid cyst, and encephalocele in a patient presenting with nasal cellulitis.  


Dermoid cysts, encephaloceles, and dermal sinus tracts represent abnormalities that develop during the process of embryogenesis. The elucidation of the precise timing of formation for these malformations has remained elusive at the molecular level of study. Yet, clinical experience has demonstrated that these malformations do not all occur in the same patient, suggesting a shared pathway that goes awry at distinct points for different patients, resulting in 1 of the 3 malformations. Herein the authors describe a case in which all 3 malformations were present in a single patient. This is the first description in the English literature of a sincipital encephalocele occurring with a dermoid cyst and a dermal sinus tract. PMID:23140217

Karandikar, Mahesh; Yellon, Robert F; Murdoch, Geoffrey; Greene, Stephanie



Un modèle non-linéaire de prolifération cellulaire : extinction des cellules et invariance  

Microsoft Academic Search

This Note analyses a nonlinear age-maturity structured system which arises as a model of the blood cellular production in the bone marrow. The resulting model is a nonlinear first-order partial differential equation in which there is a distributed temporal delay and a retardation in the maturation variable. We prove that uniqueness of solutions depends only on small maturity cells (stem

Mostafa Adimy; Fabien Crauste



L'ultra-structure du nucléole de quelques cellules animales, révélée par le microscope électronique  

Microsoft Academic Search

Zusammenfassung Elektronenoptische Untersuchungen von Ultrafeinschnitten der Rattenleber sowie einiger anderer Gewebe dieses Tieres, ferner eines Mammakarzinoms der Maus und der Niere des Menschen haben ergeben, daß der Nukleolus des Zellkerns oft eine besondere Struktur aufweist: Auf genügend dünnen Schnitten (0,2µ>) erscheint sehr häufig ein Knäuel fadiger Elemente von verschiedener Länge, aber annähernd gleicher Dicke, die für die Gesamtheit des Nukleolus

W. Bernhard; F. Haguenau; Ch. Oberling



Alcuni aspetti delle cellule follicolari e della nuvola mitocondriale nell'ovogenesi di Rana synklepton esculenta  

Microsoft Academic Search

In this paper the presence of a novel protein, p27BBP and of cytokeratin were studied with an immunocytochemical approach in Rana synklepton esculenta oogenesis. It has been shown in mammals that p27BBP, is a constituent of the plasma membrane of malignant and normal epithelial cells, associated with the cytoplasmic tail of integrin ?4 and\\/or bound to intermediate filaments. p27BBP is



Etude de la distribution générale des 46 chromosomes dans les cellules humaines en métaphase  

Microsoft Academic Search

This study, based on the square distances of chromosome centromeres from the center of a cell, shows after circular transformation, that the general dispersion of the 46 chromosomes is uniform, except on the periphery of the cell. It is found that the chromosomes taken separately have not a random distribution, but have peculiar positions. In males, chromosomes 1, 13-14-15 and

H. Galperin



Identification des cellules hypophysaires sécrétant l'ACTH chez le rat  

Microsoft Academic Search

In order to clarify the identity of the ACTH-secreting cells in the rat pituitary, morphological studies were performed in adrenalectomized rats which have a specific increase in ACTH secretion. Pituitaries were removed and fixed for both light and electron microscopy at different time intervals (1 to 21 days) after adrenalectomy. Pituitaries of adrenalectomized animals which received dexamethasone, a potent inhibitor

Georges Pelletier; Jean Racadot



Origine des messages somato-sensitifs activant les cellules du cortex moteur chez le singe  

Microsoft Academic Search

Previous experiments in monkey motor cortex have described activity evoked by somatic stimulation. The aim of the present work was to study the properties and peripheral origins of this projection at the level of single cells. To this end, electric and natural stimuli have been used and dissections of peripheral tissues have frequently been made. Parallel experiments in the post-rolandic

Denise Albe-Fessard; John Liebeskind



Concurrent endophthalmitis and orbital cellulitis in a child with congenital glaucoma and a glaucoma drainage device  

PubMed Central

Summary A 3-year-old monocular boy with a history of congenital glaucoma and aqueous shunt implantation presented with periorbital swelling, erythema, and purulent discharge in his seeing right eye. Examination revealed an extensive hypopyon. Computed tomography (CT) showed right-sided proptosis, and a displaced aqueous shunt device deep in the orbit. Significant purulent fluid was encountered when the device was removed; vitreous and orbital cultures revealed Streptococcus pneumoniae. The patient received intravitreal, topical, intravenous, and oral antibiotics as well as intraocular tissue plasminogen activator and topical steroid. Orbital and intraocular inflammation decreased significantly but he developed a cataract, further complicated by a retinal detachment.

Kassam, Faazil; Lee, Bonita E.; Damji, Karim F.



A Deceptive Case of Cellulitis Caused by a Gram-Negative Pathogen  

PubMed Central

Yokenella regensburgei is a member of the family Enterobacteriaceae that has rarely been implicated in clinical disease. We report here a case of septicemia with a skin and soft tissue source caused by Y. regensburgei in an immunocompromised host.

Weinstein, M. P.



Modifications des cellules corticotropes de l'hypophyse chez l'anguille radiothyroïdectomisée  

Microsoft Academic Search

Eels were completely or sub-totally radiothyroidectomized with repeated injections of high doses of radioiodine 131I. After 2 to 8 months, the histological picture of the interrenal suggests a hypoactivity, indicated by a nuclear and nucleolar atrophy. Simultaneously, in the pituitary gland, the corticotrophic cells are smaller, less granulated with a finely vacuolated apical cytoplasm. The diameter of their nuclei is

Madeleine Olivereau



Effects of yeast extract and vitamin D on turkey mortality and cellulitis incidence in a transport stress model.  

Technology Transfer Automated Retrieval System (TEKTRAN)

We evaluated yeast extract (YE) and vitamin D (VD) in turkeys treated with dexamethasone (Dex) at intervals designed to simulate transport stress during a 3 stage growout. YE but not VD decreased early mortality (P = 0.001) and mortality at wk 7 (P= 0.02) and wk 12 (P = 0.002) but not wk 16. Celluli...


Un mod\\\\`ele non-lin\\\\'eaire de prolif\\\\'eration cellulaire : extinction des cellules et invariance  

Microsoft Academic Search

This paper analyses a nonlinear age-maturity structured system which arises as a model of the blood cellular production in the bone marrow. The resulting model is a nonlinear first-order partial differential equation in which there is a distributed temporal delay and a retardation in the maturation variable. We prove that uniqueness of solutions depends only on small maturity cells (stem

Mostafa Adimyet; Fabien Crauste



Influenza delle cellule satelliti sullo sviluppo delle propaggini del corpo dei neuroni dei gangli spinali di coniglio  

Microsoft Academic Search

\\u000a Abstract  A large number of slender projections arise from the perikarya of spinal ganglion neurons. By expanding the area available\\u000a for exchange of metabolites, these projections may be important in neuronal metabolism. We previously showed that the outgrowth\\u000a of these projections, while an intrinsic property of the spinal ganglion neurons, is also influenced by the surrounding microenvironment.\\u000a Since the latter consists

Maria Ledda; Patrizia Procacci; Ennio Pannese



Mycobacterium abscessus cellulitis and multifocal abscesses of the breasts in a transsexual from illicit intramammary injections of silicone  

Microsoft Academic Search

We report the case of a 29-year-old transsexual who developed Mycobacterium abscessus infection after receiving intramammary liquid silicone injections in the nonphysician office setting. Our patient represents 1 of 14 confirmed and 11 suspected cases in New York City of M abscessus infection after illicit cosmetic procedures. As injectable cosmetic procedures are becoming increasingly popular, dermatologists should be aware of

Lindy Peta Fox; Adam S Geyer; Sameera Husain; Phyllis Della-Latta; Marc E Grossman



Mucormycosis Caused byRhizopus microsporusvar.microsporus: Cellulitis in the Leg of a Diabetic Patient Cured by Amputation  

Microsoft Academic Search

Mucormycosis accompanied the development of bacterial infection in the leg of a diabetic African-American man. Local injury, diabetic ketoacidosis, renal insufficiency, and antimicrobial therapy were factors that con- tributedtothepathogenesisofthemucormycosis.ThecellulitiswascausedinpartbyRhizopusmicrosporusvar. microsporusandwascuredbyamputation.Wereportthisunusualcaseofmucormycosistoemphasizethevalue of fungal identification, to illustrate a dramatic and successful clinical result, and to draw attention to an apparentroleforbacterialinfectionanditstreatmentinthepathogenesisofmucormycosis.Itisthethirdcase report of mucormycosis in a human in whichR. microsporusvar.microsporuswas definitively identified as




Necrotizing cellulitis of the abdominal wall, caused by Pediococcus sp., due to rupture of a retroperitoneal stromal cell tumor  

PubMed Central

INTRODUCTION Soft tissue necrotizing infections are a significant cause of morbidity and mortality. The aim of this study is to present a patient with necrotizing infection of abdominal wall resulting from the rupture of a retroperitoneal stromal tumor. PRESENTATION OF CASE We present a 60-year-old Caucasian male patient with necrotizing infection of abdominal wall secondary to the rupture of a retroperitoneal stromal tumor. The patient was initially treated with debridement and fasciotomy of the anterior abdominal wall. Laparotomy revealed purulent peritonitis caused by infiltration and rupture of the splenic flexure by the tumor. Despite prompt intervention the patient died 19 days later. The isolated microorganism causing the infection was the rarely identified as cause of infections in humans Pediococcus sp., a gram-positive, catalase-negative coccus. DISCUSSION Necrotizing infections of abdominal wall are usually secondary either to perineal or to intra-abdominal infections. Gastrointestinal stromal cell tumors could be rarely complicated with perforation and abscess formation. In our case, the infiltrated by the extra-gastrointestinal stromal cell tumor ruptured colon was the source of the infection. The pediococci are rarely isolated as the cause of severe septicemia. CONCLUSION Ruptured retroperitoneal stromal cell tumors are extremely rare cause of necrotizing fasciitis, and before this case, Pediococcus sp. has never been isolated as the responsible agent.

Michalopoulos, Nick; Arampatzi, Stergiani; Papavramidis, Theodossis S.; Kotidis, Efstathios; Laskou, Styliani; Papavramidis, Spiros T.



21 CFR 520.88g - Amoxicillin trihydrate and clavulanate potassium film-coated tablets.  

Code of Federal Regulations, 2010 CFR

...infections such as wounds, abscesses, cellulitis, superficial/juvenile and deep...Limitations. Wounds, abscesses, cellulitis, and superficial/juvenile pyoderma...infections, such as wounds, abscesses and cellulitis/dermatitis due to susceptible...



Rôle des cellules TCD4+ suppressives dans la pathogénie des maladies auto-immunes (dont la polyarthrite rhumatoïde). Faits et hypothèses  

Microsoft Academic Search

Although uncontrolled clones of autoreactive T cells play a central role in the pathogenesis of autoimmunity, another mechanism potentially involved in many autoimmune diseases is deficiency of suppressor T cells, most notably those belonging to the antiidiopeptide TH3\\/Tr1 TCD4+CD25+(high) subset. Failure of suppressor mechanisms may be in part primary, due to defective positive selection of suppressor T cells in the

Jean-Marie Berthelot; Yves Maugars



Radiothérapie stéréotaxique des cancers broncho-pulmonaires non à petites cellules : d’un concept à une réalité clinique. Actualités en 2011  

Microsoft Academic Search

Only 60% of patients with early-stage non-small cell lung cancer (NSCLC), a priori bearing a favorable prognosis, undergo radical resection because of the very frequent co-morbidities occurring in smokers, precluding surgery to be safely performed. Stereotactic radiotherapy consists of the use of multiple radiation microbeams, allowing high doses of radiation to be delivered to the tumour (ranging from 7.5 to

N. Girard; F. Mornex



Feasibility study to inform the design of a UK multi-centre randomised controlled trial of prophylactic antibiotics for the prevention of recurrent cellulitis of the leg  

Microsoft Academic Search

BACKGROUND: This paper describes the results of a feasibility study for a randomised controlled trial (RCT). METHODS: Twenty-nine members of the UK Dermatology Clinical Trials Network (UK DCTN) expressed an interest in recruiting for this study. Of these, 17 obtained full ethics and Research & Development (R&D) approval, and 15 successfully recruited patients into the study. A total of 70

Kim S. Thomas; Neil H. Cox; Boki S. P. Savelyich; Debbie Shipley; Sarah Meredith; Andrew Nunn; Nick Reynolds; Hywel C. Williams



Variations des concentrations de cAMP intracellulaire de différents types de cellules après infection par le virus Sendaï ou le virus de la stomatite vésiculeuse  

Microsoft Academic Search

Summary In KB cells, MRC5 and adult skin fibroblasts infected by low doses of Sendaï virus, intracellular cyclic AMP levels rose and fell in the first hours following infection, then remained lower than basal level during at least 2 days in KB cells and adult skin fibroblasts. When compared to other viruses or cAMP inducers previously described, this effect appeared

P. Vallier; J. Farjanel; J. Bata; P. Deviller



Effets du gemmage sur l'ultrastructure des cellules sécrétrices des canaux de l'écorce des tiges de Pinus sylvestris L. et Picea abies (L.) Karst  

Microsoft Academic Search

Summary The terpene synthesis by the resin canal cells of the bark in the twigs ofPinus andPicea ceases at the end of the elongation period of the first year shoot. After this secretory period, the epithelial cells undergo a progressive dedifferentiation and store ergastic material. The secretory potentiality may be reactivated by tapping. The first obvious features are the multiplication

A. E. Vassiliev; J. P. Carde



Nouvelles données sur la régulation de la sécrétion du glucagon par les cellules alpha des îlots pancréatiques et son importance dans le diabète  

Microsoft Academic Search

Le diabète est la principale cause de mortalité en Amérique du Nord et, au Canada uniquement, plus de 2 millions de personnes en sont atteints. L'hyperglycémie est le signe caractéristique du diabète et une cause prédominante de l'apparition de complications à long terme associées à la maladie. Dans des conditions normales, un taux accru de glucose stimule la sécrétion d'insuline



Lemierre's syndrome due to community-acquired meticillin-resistant Staphylococcus aureus infection and presenting with orbital cellulitis: a case report  

PubMed Central

Introduction Lemierre's syndrome is septic thrombophlebitis of the internal jugular vein leading to metastatic septic complications following an oropharyngeal infection. It is usually caused by the anaerobe, Fusobacterium necrophorum. Of late, meticillin-resistant Staphylococcus aureus is increasingly being recognised as a cause of community-acquired skin and soft tissue infections. We report a rare case of Lemierre's syndrome caused by community-acquired meticillin-resistant Staphylococcus aureus infection. Case presentation A previously healthy 16-year-old girl presented with fever of 13 days duration, painful swelling around the right eye and diplopia followed by the appearance of pulmonary infiltrates. Imaging studies confirmed the clinical suspicion of bilateral jugular venous thrombosis with septic pulmonary embolism. Meticillin-resistant Staphylococcus aureus was isolated on blood cultures. The hospital course was complicated by massive haemoptysis and pulmonary aspiration necessitating mechanical ventilation. The patient subsequently made a complete recovery. Conclusion Lemierre's syndrome, although rare, is a potentially lethal but treatable complication of head and neck sepsis. Early clinical recognition of Lemierre's syndrome and appropriate antibiotic treatment can be life-saving. One should consider the possibility of community-acquired meticillin-resistant Staphylococcus aureus infection in patients with suspected Lemierre's syndrome.

Kadhiravan, Tamilarasu; Piramanayagam, Paramasivan; Banga, Amit; Gupta, Rajiva; Sharma, Surendra K



Localisation autoradiographique des ions Cl ? et Na + dans les cellules à chlorure de la branchie d'anguille ( Anguilla anguilla L.) adaptée à l'eau de mer  

Microsoft Academic Search

With an autoradiographic technique Cl- and Na+ ions have been shown to be localized in the chloride cells of sea water eel gills. The significance of this accumulation, more marked towards the apical pole of these cells, is discussed with regard to branchial excretion of these ions in sea water.

A. Masoni; F. Garcia-Romeu



21 CFR 520.88h - Amoxicillin trihydrate and clavulanate potassium for oral suspension.  

Code of Federal Regulations, 2010 CFR and soft tissue infections such as wounds, abscesses, cellulitis, superficial/juvenile and deep pyoderma due to susceptible...and soft tissue infections, such as wounds, abscesses and cellulitis/dermatitis due to susceptible strains of...



Eyes - bulging  


... very serious sign. It should be checked immediately. Hyperthyroidism (particularly Graves disease ) is the most common cause ... Glaucoma Graves disease Hemangioma Histiocytosis Hyperthyroidism ... Orbital cellulitis or periorbital cellulitis Rhabdomyosarcoma


Tomographie par émission de positons et détection en coïncidence (TEDC) et recalage d'images de simulation virtuelle par tomodensitométrie. Impact sur la planification de la radiothérapie conformationnelle des cancers bronchiques non à petites cellules  

Microsoft Academic Search

To report a retrospective study concerning the impact of fused 18F-fluorodeoxy-D-glucose (FDG)-hybrid positron emission tomography (PET) and computed tomography (CT) images on three-dimensional conformal radiation therapy (3D-CRT) planning for patients with non-small-cell lung cancer (NSCLC).Patients and methods. – One hundred and one patients consecutively treated for stages I–III NSCLC were studied. Each patient underwent CT and FDG-hybrid PET for simulation

E. Deniaud-Alexandre; E. Touboul; D. Lerouge; D. Grahek; J. N. Foulquier; Y. Petegnief; B. Grès; H. El Balaa; K. Keraudy; K. Kerrou; F. Montravers; B. Milleron; B. Lebeau; J.-N. Talbot



Évaluation des rythmes d’activité et de repos chez des patients porteurs d’un cancer pulmonaire non à petites cellules (CPNPC) de stade avancé. Rôle de la corticothérapie ?  

Microsoft Academic Search

The circadian structure (i.e. rest-activity cycle) was evaluated by actometry in a group of 25 advanced NSCLC patients. A better circadian profile was observed in the 6 patients treated with corticosteroïds. However those patients had also a shortened survival.

C Focan; C Mormont; N Moeneclaye; D Focan-Henrard; J Waterhouse



Behaviour of glycogen and related enzymes in the sertoli cell syndrome  

Microsoft Academic Search

Riassunto Nella «sindrome da sole cellule di Sertoli congenita o idiopatica» (aplasia germinale vera) la 1–4 AP, ricercata con metodi istochimici, risulta assente in corrispondenza dell'epitelio del tubulo seminifero e si presenta in quantità apprezzabile in sede peritubulare (cellule muscolari). Nella «sindrome da sole cellule di Sertoli acquisita», conseguente a trattamento radiante, il comportamento della 1–4 AP è del tutto

A. Fabbrini; M. Re; G. Spera



78 FR 53148 - National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards...  

Federal Register 2010, 2011, 2012, 2013

...newborns Oromaxillofacial Disorders Pediatric topics Periorbital and Preseptal Cellulitis Periprosthetic Fractures Traumatic Brain Injury Unintended awareness under general anesthesia Vaccine and prophylactic immunotherapy administration...




Center for Biologics Evaluation and Research (CBER)

... Fluvirin Revised the Package Insert to include information on thrombocytopenia, cellulitis, extensive limb swelling and skin and subcutaneous ... More results from


Identification of bacteria in acute endodontic infections and their antimicrobial susceptibility  

Microsoft Academic Search

Objective. The purpose of the study was to identify the bacterial composition of the microbiota from acute endodontic abscesses\\/cellulitis and their antimicrobial susceptibilities. Study Design. Purulence from 17 patients with acute endodontic abscesses\\/cellulitis was obtained by needle aspiration and processed under anaerobic conditions. Bacteria were isolated and identified by biochemical or molecular methods. The antimicrobial susceptibility of isolated bacteria was

Saengusa Khemaleelakul; J. Craig Baumgartner; Sumalee Pruksakorn



Ocular complications of eyebrow piercing.  


Piercing, a type of body art, is increasing in popularity among young people. Two patients presented with complications a few days after having an eyebrow piercing. The first had posterior cellulitis and the second had anterior cellulitis. In both cases, symptoms decreased after 1 week of therapy with antibiotics and cortisone. PMID:18524201

Carelli, Roberta; Fimiani, Francesco; Iovine, Antonello; Vassallo, Patrizia; Magli, Adriano


Studying a disease with no home - lessons in trial recruitment from the PATCH II study  

Microsoft Academic Search

BACKGROUND: Cellulitis is a very common condition that often recurs. The PATCH II study was designed to explore the possibility of preventing future episodes of cellulitis, with resultant cost savings for the NHS. This was the first trial to be undertaken by the UK Dermatology Clinical Trials Network. As such, it was the first to test a recruitment model that

Kim S Thomas



Elevated soft tissue activity in early but not delayed phase of bone scan in Klippel-Trenaunay syndrome.  


Triple-phase bone scan is commonly used in the diagnosis of osteomyelitis. Elevated bone tracer activity in early but not delayed phase of the study favors cellulitis over osteomyelitis. We reported that Klippel-Trenaunay syndrome, a congenital disorder characterized by malformations of the capillary, venous, and lymphatic systems, can have images similar to cellulitis on triple-phase bone scan. PMID:23354038

Liu, Bin; Servaes, Sabah; Zhuang, Hongming



Analisi della cinetica di espressione della tristetraprolina e della HuR in cellule mononucleate di pazienti con artrite reumatoide dopo stimolazione con lipopolisaccaride* Analysis of the kinetic of expression of tristetraprolin and HuR by rheumatoid arthritis patients pheripheral blood mononuclear cells stimulated with lipopolysaccharide  

Microsoft Academic Search

SUMMARY Objective. Given the role of TNF-? in Rheumatoid Arthritis (RA) we decided to define the characteristics of the TNF- ? synthesis by peripheral blood mononuclear cells (PBMNCs) obtained from active-aggressive RA patients giving a particular attention to the modulation of the expression of two fundamental proteins in TNF- ? mRNA stability regu- lation, Tristetraprolin (TTP) and HuR. Methods. 11

M. Fabris; B. Tolusso; E. Gremese; P. Tomietto; G. Ferraccioli


Methods and Compositions for Monitoring Cell Migration and Identifying Clinically Relevant Cytotoxic T Lymphocyte Activity.  

National Technical Information Service (NTIS)

A three-dimensional reconstruct model containing solid layers of collagen and fibroblasts closely mimic the condition of patients in vivo, preserving in vivo phenotypic and functional characteristics of the cells. Reconstructs can be used to detect cellul...

D. Herlyn M. Herlyn R. Somasundaram




Center for Biologics Evaluation and Research (CBER)

Text Version... cessation of sporative infection and resolution of 19 ... cellulitis or wound infections was noted to be 2 ... incision and drainage alone. 7 ... More results from


Microbes and Petroleum: Perspectives and Implications.  

National Technical Information Service (NTIS)

An ultra-structure study of Acinetobacter grown on paraffinic and olefinic hydrocarbons demonstrated cytoplasmic sequestering of hydrocarbons. Induced membrane synthesis was additionally demonstrated as a result of hydrocarbon metabolism. Increased cellul...

W. R. Finnerty R. S. Kennedy P. Lockwood B. O. Spurlock R. A. Young



Streptococcal Infections  


... red rash on the body. Impetigo - a skin infection Toxic shock syndrome Cellulitis and necrotizing fasciitis (flesh-eating disease) Group B strep can cause blood infections, pneumonia and meningitis in newborns. A screening test ...


Management of orbital complications of sinusitis in pediatric patients.  


The most common reason of orbital infections is sinusitis. Orbital complications of sinusitis are mostly seen in children. Loss of vision and intracranial infections are among the complications of sinusitis. Prompt diagnosis and treatment is very important in the management of orbital complications. The orbital complication can be in the form of cellulitis or abscess. A retrospective review of 26 pediatric patients with orbital complications due to sinusitis was presented in this study. Of 26 patients, there were 13 cases of preseptal cellulitis, 2 cases of orbital cellulitis, and 11 cases of subperiosteal abscess. We grouped the preseptal and orbital cellulites in one category and the subperiosteal abscess in the other. All patients in the cellulitis group recovered by medical treatment. All the patients were treated by surgical drainage. Early diagnosis and appropriate treatment method are vital for the treatment of orbital complications secondary to sinusitis. PMID:24036759

Kinis, Vefa; Ozbay, Musa; Bakir, Salih; Yorgancilar, Ediz; Gun, Ramazan; Akdag, Mehmet; Sahin, Muhammed; Topcu, Ismail



38 CFR 4.104 - Schedule of ratings-cardiovascular system.  

Code of Federal Regulations, 2010 CFR

...pressure, and tachycardia 60 Without cardiac involvement but with edema, stasis dermatitis, and either ulceration or cellulitis: Lower extremity 50 Upper extremity 40 With edema or stasis dermatitis: Lower extremity 30 Upper...



Nikolsky’s sign  


Pasternack MS, Swartz MN. Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases . 7th ed. Philadelphia, ...


Genome sequence of the human-pathogenetic bacterium Vibrio vulnificus B2.  


Vibrio vulnificus, which can lead to rapidly expanding cellulitis or septicemia, is present in the marine environment. Here, we present the draft genome sequence of strain B2, which was isolated from a septicemia patient in 2010. PMID:23209257

Wang, Zhi-Gang; Wu, Zhan; Xu, Shui-Ling; Zha, Jia



Facteurs impliqués dans le remodelage de la chromatine au cours de la spermiogenèse  

Microsoft Academic Search

Resume  Les spermatides rondes sont les cellules issues de la méiose dont le noyau haploïde présente initialement une structure similaire\\u000a à celle d’une cellule somatique. Au cours de la maturation post-méiotique de la spermatide, ou spermiogenèse, la chromatine\\u000a subit un remodelage au cours duquel le noyau de la spermatide s’allonge puis se condense pour former le noyau spermatique,\\u000a dont la chromatine

Sophie Rousseaux; Cécile Caron; Christophe Pivot-Pajot; Anne Karen Faure; Mira Hazzouri; Bernard Sele; Saadi Khochbin



Microbiology and management of soft tissue and muscle infections.  


This review summarizes the microbiological aspects and management of soft tissue and muscle infections. The infections presented are: impetigo, folliculitis, furunculosis and carbuncles, cellulitis, erysipelas, infectious gangrene (includes necrotizing fasciitis or streptococcal gangrene, gas gangrene or clostridium myonecrosis, anaerobic cellulites, progressive bacterial synergistic gangrene, synergistic necrotizing cellulitis or perineal phlegmon, gangrenous balanitis, and gangrenous cellulitis in the immunocompromised patient), secondary bacterial infections complication skin lesions, diabetic and other chronic superficial skin ulcers and subcutaneous abscesses and myositis. These infections often occur in body sites or in those that have been compromised or injured by foreign body, trauma, ischemia, malignancy or surgery. In addition to Group A streptococci and Staphylococcus aureus, the indigenous aerobic and anaerobic cutaneous and mucous membranes local microflora usually is responsible for polymicrobial infections. These infections may occasionally lead to serious potentially life-threatening local and systemic complications. The infections can progress rapidly and early recognition and proper medical and surgical management is the cornerstone of therapy. PMID:17720643

Brook, Itzhak



[Ethmoidal fracture. Differential diagnosis of orbital cellulites in pediatrics. Clinical case].  


We report a case of orbital emphysema secondary to ethmoidal fracture after minimal trauma as differential diagnosis of orbital cellulitis not reported before in children. An 8 year-old girl with diagnosis of orbital cellulitis was remitted for admittance, IV antibiotics and evaluation by an ophthalmologist. However, further evaluation led to a diagnosis of ethmoidal lamina papyracea fracture. Patient showed complete resolution in 4 days with outpatient treatment. Once again, this case corroborates that meticulous history taking and physical examination are irreplaceable for decision making. PMID:21132223

Slavsky, Anahí; Fraga, Jimena; González Frea, Guillermina; Ronchetti, María P; Miauro, Jorge; Castagna, Anabella; Sturla, Fabio; Selandari, Jorge



A retrospective electronic-chart review to determine if cultures should be routinely utilized for skin and soft tissue infections in the Emergency Department at Legacy Emmanuel Hospital  

Microsoft Academic Search

Background. Soft tissue skin infections rank among the most common diagnosis in hospitalized patients in America, yet attempts to culture these infections often demonstrates no definitive pathogen. Low yields for positive cultures is often demonstrated when culturing cellulitis, however, the yield is much greater with abscess cultures. Over the past decade, several clinical trials have shown etiologic organisms in less

Kristofer McAllister



HORACE: A compact cold atom clock for Galileo  

Microsoft Academic Search

HORACE (HOrloge à Refroidissement d’Atomes en Cellule=clock based on atoms cooled from vapour cell) is a compact cold caesium atom clock developed in SYRTE at Paris Observatory. This clock can operate both on ground and in microgravity environment. Design of HORACE is based on isotropic light cooling, allowing performing the whole clock sequence (cooling, atomic preparation, Ramsey interrogation and detection)

F. X. Esnault; N. Rossetto; D. Holleville; J. Delporte; N. Dimarcq




Microsoft Academic Search

SUMMARY: Necrotizing infections of soft tissues vary in their clinical presentation, but they are grave entities associated with high mortality rates. Clinical presentation involves fever, cellulitis, edema, crepitus, bullae, necrosis and sepsis; although in most cases a history of trauma or surgery is present. Surgical findings include skin and subcutaneous tissue necrosis with or without myonecrosis. The treatment is prompt

Luis Ignacio Arjol; Fausto Rafael Ayala Ortiz; Sandra Elizabeth Bernachea


M?tastase pancr?atique m?tachrone du cancer du rein : ? propos d'un cas  

PubMed Central

Résumé Les métastases pancréatiques du cancer du rein sont rares et surviennent le plus souvent plusieurs années après la néphrectomie. Le traitement chirurgical est souvent possible, permettant une bonne survie à distance. Nous rapportons le cas d’une métastase pancréatique métachrone d’un carcinome rénal à cellules claires 16 ans après la néphrectomie.

Mqirage, Mohammed; Egurrola, Jose Antonio Zabala; Rodriguez, Jorge Garcia-Olaverri; Pena, Carlos Pertusa



Fulminant meningococcal supraglottitis: An emerging infectious syndrome?  

PubMed Central

We report a case of fulminant supraglottitis with dramatic external cervical swelling due to associated cellulitis. Blood cultures were positive for Neisseria meningitidis. The patient recovered completely after emergency fiberoptic intubation and appropriate antibiotic therapy. We summarize five other cases of meningococcal supraglottitis, all reported since 1995, and discuss possible pathophysiologic mechanisms.

Schwam, E.; Cox, J.



Mucormicosis rinocerebral: Sobrevida en un niño con leucemia  

Microsoft Academic Search

A four year old child with acute lymphoblastic leukemia and severe neutropenia secondary to chemotherapy, presented with periorbitarian cellulitis and proptosis of the right eye. Initially it was supposed to have a bacterial origin but he didn't improve with antibiotic treatment. As MRI detected a cerebritis focus, three surgical drainages and debridements were done and a nasal osseus biopsy confirmed



Quality Control in Chronic Wound Management: The Role of Local PovidoneIodine (Betadine®) Therapy  

Microsoft Academic Search

Background: The treatment of venous leg ulcers is often inadequate, because of incorrect diagnosis, overuse of systemic antibiotics and inadequate use of compression therapy. Stasis dermatitis related to chronic venous insufficiency accompanied by infected superficial ulcers must be differentiated from erysipelas, cellulitis and contact eczema. Objectives: To assess the effectiveness of (1) topical povidone-iodine with and (2) without compression bandages,

Judit Daróczy



Versamento pleurico maligno secondario  

Microsoft Academic Search

Il riscontro di cellule maligne nel liquido pleurico è indicatore di malattia tumorale disseminata o avanzata, evento clinico\\u000a quindi sfavorevole, poiché condizionante la qualità di vita e l’aspettativa di soprawivenza del paziente, ridotta mediamente\\u000a a 3–12 mesi, in relazione peraltro allo stadio e alla sede della neoplasia primitiva [1–4].

Paolo Noceti; Marco Nosenzo


16S rRNA sequence analysis of an isolate of Mycobacterium haemophilum from a heart transplant patient  

Microsoft Academic Search

Summary. Biopsy samples from a heart transplant patient with cellulitis and bursitis yielded an isolate of Mycobacterium haemophilum. The isolate was identified on the basis of a growth requirement for haemin or ferric ammonium citrate, growth at 30°C but not at 37\\

CATHERINE H. ZAPPE; D. Barlow; H. Zappe; I. J. Bolton; D. Roditi; L. M. Steyn



Eye Problems  


... Yes These may be signs of a serious eye infection called PERIORBITAL CELLULITIS. URGENT SEE YOUR DOCTOR RIGHT AWAY. No 12. Is there a firm, painful lump in the ... 13. Is the white of the eye pink, red or irritated, and are there any ...


Lutte contre les maladies sexuellement transmises au Sénégal  

Microsoft Academic Search

Résumé Les maladies sexuellement transmises (MST) sont un problème de santé publique important dans de nombreux pays en développement. Bien qu'on dispose de moyens diagnostiques et thérapeutiques satisfaisants, leur incidence augmente. Parmi les causes qui favorisent cette évolution, il faut noter des facteurs sociologiques, comme l'affaiblissement de la cellule familiale et le bouleversement des coutumes, ainsi que le développement du

J. Ridet; Ph. Selby



Accuracy of computerized tomography in deep neck infections in the pediatric population  

Microsoft Academic Search

Objectives: Computerized tomography (CT) is used widely to diagnose deep neck infections (DNIs), and, generally, the decision of surgical intervention is based on findings of a CT study. This study examines the accuracy of CT in differentiating abscess versus cellulitis in DNIs (lateral pharyngeal and retropharyngeal).Study Design: This is a retrospective chart review study with re-evaluation of the CT scans

Cetin Vural; Susan Comerci



Alternaria fungal dermatitis in a free-ranging javelina (Pecari tajacu).  


We report a javelina from Pinal County, Arizona, USA, with severe fungal dermatitis and cellulitis. Extreme emaciation and rostral disfiguration, including left-lateral displacement of the nasal planum, justified euthanasia. A pus-filled tract within the rostrum was observed. Histopathology revealed granulomatous inflammation with hyphae morphologically consistent with Alternaria sp. isolated by culture. PMID:21719857

Shender, Lisa A; Gerhold, Rick; Sanchez, Susan; Keel, M Kevin



Roseomonas gilardii Infection: Case Report and Review  

PubMed Central

Roseomonas gilardii is a bacterium that has been indicated as a rare cause of human infections. The case of a patient presenting with cellulitis and bacteremia secondary to R. gilardii is described together with the clinical characteristics of infection with this organism obtained from a review of cases previously reported.

Shokar, Navkiran K.; Shokar, Gurjeet S.; Islam, Jamal; Cass, Alvah R.



Roseomonas gilardii infection: case report and review.  


Roseomonas gilardii is a bacterium that has been indicated as a rare cause of human infections. The case of a patient presenting with cellulitis and bacteremia secondary to R. gilardii is described together with the clinical characteristics of infection with this organism obtained from a review of cases previously reported. PMID:12454198

Shokar, Navkiran K; Shokar, Gurjeet S; Islam, Jamal; Cass, Alvah R



Management of a gunshot wound in a mare  

PubMed Central

A 5-year-old, Quarter horse mare was treated for severe cellulitis secondary to a gunshot wound near the right humerus. The bullet was not retrieved due to the risk of damaging the radial nerve or elbow joint. Despite the presence of the bullet, the mare resumed athletic soundness once the infection had resolved.

Mellish, Martha A.; Adreani, Christine M.



Increased Serum Levels of Epidermal Growth Factor in Children with Autism  

ERIC Educational Resources Information Center

|The etiology of autism is unclear, however autism is considered as a multifactorial disorder that is influenced by neurological, environmental, immunological and genetic factors. Growth factors, including epidermal growth factor (EGF), play an important role in the celluler proliferation and the differentiation of the central and peripheral…

Iseri, Elvan; Guney, Esra; Ceylan, Mehmet F.; Yucel, Aysegul; Aral, Arzu; Bodur, Sahin; Sener, Sahnur



Chronic osteomyelitis of the clavicle  

Microsoft Academic Search

Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite

Mark S. Granick; Sai S. Ramasastry; Mark A. Goodman; Robert Hardesty



Necrotizing soft tissue infections of the body wall: Computed tomographic evaluation  

Microsoft Academic Search

The spectrum of soft tissue infection ranges from cellulitis to uncommon, but potentially fatal, diseases like necrotizing fasciitis and myonecrosis. The severity and extent of infection can be difficult to assess by physical examination alone. Computed tomography can accurately define the location and extent of infection as well as aid in its characterization. This information is critical in guiding surgical

Kelly M. Sledz; Deborah S. Granke; Akella Chendrasekhar; Jeffery P. Hogg



Lipodermatosclerosis: a clinicopathologic study of 17 cases and differential diagnosis from erythema nodosum  

Microsoft Academic Search

Background: The clinical manifestations of lipodermatosclerosis (LDS) may mimic cellulitis and various panniculitides. Methods: To better characterize the histopathologic changes of LDS, we reviewed the clinicopathologic findings of 26 cases with a pathologic diagnosis consistent with LDS. A final diagnosis of LDS was made in 17 cases based on the clinicopathological correlation. As some cases manifested erythema nodosum (EN)-like lesions,

Tsung-Mao Huang; Julia Y.-Y. Lee



Small molecules that recapitulate the early steps of urodele amphibian limb regeneration and confer multipotency.  


In urodele amphibians, an early step in limb regeneration is skeletal muscle fiber dedifferentiation into a cellulate that proliferates to contribute new limb tissue. However, mammalian muscle cannot dedifferentiate after injury. We have developed a novel, small-molecule-based method to induce dedifferentiation in mammalian skeletal muscle. Muscle cellularization was induced by the small molecule myoseverin. Candidate small molecules were tested for the induction of proliferation in the cellulate. We observed that treatment with the small molecules BIO (glycogen synthase-3 kinase inhibitor), lysophosphatidic acid (pleiotropic activator of G-protein-coupled receptors), SB203580 (p38 MAP kinase inhibitor), or SQ22536 (adenylyl cyclase inhibitor) induced proliferation. Moreover, these proliferating cells were multipotent, as confirmed by the chemical induction of mesodermal-derived cell lineages. Microarray analysis showed that the multipotent, BIO-treated cellulate possessed a markedly different gene expression pattern than lineage-restricted C2C12 myoblasts, especially for genes related to signal transduction and differentiation. Sequential small molecule treatment of the muscle cellulate with BIO, SB203580, or SQ22536 and the aurora B kinase inhibitor, reversine, induced the formation of cells with neurogenic potential (ectodermal lineage), indicating the acquirement of pluripotency. This is the first demonstration of a small molecule method that induces mammalian muscle to undergo dedifferentiation and rededifferentiation into alternate cell lineages. This method induces dedifferentiation in a simple, stepwise approach and has therapeutic potential to enhance tissue regeneration in mammals. PMID:22270490

Kim, Woong-Hee; Jung, Da-Woon; Kim, Jinmi; Im, Sin-Hyeog; Hwang, Seung Yong; Williams, Darren R



Skin Infections  


... it can get infected by them. Some common types of skin infections are Bacterial: Cellulitis and impetigo. Staphylococcal infections can also affect the skin. Viral: Shingles, warts, and herpes simplex Fungal: Athlete's foot and yeast infections Parasitic: Body lice, head lice, and scabies ...


Presence of modified fibroblasts in granulation tissue and their possible role in wound contraction  

Microsoft Academic Search

Résumé Au cours de la contraction du tissu de granulation, de nombreux fibroblastes acquièrent des caractéristiques ultrastructurelles qui les rendent semblables à des cellules musculaires lisses. Il est probable que ces éléments modifiés jouent un rôle dans le processus de contraction des plaies.

G. Gabbiani; G. B. Ryan; G. Majno



Cellulite nécrosante périnéale révélant un adénocarcinome rectal  

Microsoft Academic Search

We report one case of rectal cancer disclosed by a perineal cellulitis in a diabetic woman. This infrequent association has a bad prognosis. Diagnosis is mainly clinical. Treatment is urgent with large spectrum antibiotic therapy, surgical debridement, colostomy and hyperbaric oxygen if available. Surgical treatment of the rectal cancer can be done immediately or delayed.

A Lamy; B Tissot; F Pigot



Necrotizing Skin and Soft-Tissue Infections Associated with Septicemia: 7 Cases Report and Review  

Microsoft Academic Search

The authors report seven cases of necrotizing skin and soft- tissue infections, with clinical presenting as hemorrhagic bullae, gangrenous cellulitis or necrotizing fasciitis, in association with septicemia, between January 2003 and January 2007 in Hat Yai Hospital. Six were male and the majority of the lesions, six cases, occurred in the lower extremities. The average age of the patients was


Partial nervous control of the avian ultimobranchial body  

Microsoft Academic Search

Résumé Le corps ultimobranchial de la poule a une forte innervation, provenant en particulier du nerf vague. On a constaté que des fibres nerveuses se terminent sur quelques groupes de cellules C. La stimulation du vague produit une chute significative du taux de calcium du plasma, ce qui démontre les propriétés d'un effet provoqué par voie parasympathique. On propose l'hypothèse

R. D. Hodges; R. P. Gould



The history holds the key in this gardener with a skin infection Staphylococci and streptococci are the most common causes of skin infections—but when the patient is immunocompromised, keep other causative organisms in mind as well. CASE REPORT  

Microsoft Academic Search

CASE The patient is a 75-year-old retired white male with a 3- day history of a papular abscess on and cellulitis of the ulnar aspect of the fifth digit on the right hand. He had presented to the emergency department (ED) and was referred to orthopedic surgery for consultation. At the con- sultation, the patient reported increased redness, streaking, and

Tara A. Lykowski; Emil R. Orpilla; Richard J. Hayek


Bone scintigraphy for neonatal osteomyelitis: simulation by extravasation of intravenous calcium  

SciTech Connect

Intravenously administered calcium gluconate has become increasingly popular in the treatment of neonatal tetany. Occasionally, extravasation results in cellulitis, leading to a clinical diagnosis of superimposed osteomyelitis. Osseous scintigraphy, as the accepted modality in the early detection of osteomyelitis, would tend to be used in this circumstance. This case illustrates a false-positive result, probably due to soft-tissue calcification.

Balsam, D.; Goldfarb, C.R.; Stringer, B.; Farruggia, S.



Lemierre's Syndrome: A serious complication of an odontogenic infection  

Microsoft Academic Search

Necrobacillosis, postanginal septicaemia or Lemierre's Syndrome is characterised by suppurative thrombophle- bitis of the internal jugular vein with embolization to several sites, including the lungs. We report the case of a 38-year-old man who was initially hospitalized because of odontogenic cellulitis. Given the deterioration of his clinical state (septic shock and multiple organ failure), neck computed tomography was performed, revealing

Pablo Rosado; Lorena Gallego; Luis Junquera; Juan C. de Vicente



Technology Transfer Automated Retrieval System (TEKTRAN)

Lignocelluloses of grasses are potential sources of biofuel to expand the bioethanol industry based on corn grain. Crop yield and biomass are high for grasses, thus offering potential substrate for fermentation. Cell wall aromatics in grass lignocelluloses, however, impede biodegradation by cellul...


Bullous erysipelas: A retrospective study of 26 patients  

Microsoft Academic Search

Background: Erysipelas is a superficial form of cellulitis caused by a variety of microbes, and it responds to antibiotic treatment. During the past few years we treated several patients with a bullous form of erysipelas involving the lower legs. We believe their disease had a more protracted course than patients with nonbullous erysipelas. Objective: We studied bullous erysipelas by conducting

Dror Guberman; Leon T. Gilead; Abraham Zlotogorski; Julian Schamroth



Gas gangrene infection of the eyes and orbits  

Microsoft Academic Search

The literature on Clostridium perfringens infections is reviewed up to 1983. An additional case is reported with bilateral clostridial infections of the eye and orbit. One eye followed the classical course of relentless panophthalmitis, amaurosis, and orbital cellulitis ending in enucleation. The second eye contained intracameral mud and gas bubbles that were removed by vitrectomy instrumentation. Subsequent removal of the

G W Crock; W J Heriot; P Janakiraman; J M Weiner



Children's Ophthalmologic Problems.  

ERIC Educational Resources Information Center

|The author points out the need for early screening for ophthalmologic disorders and reviews symptoms of various eye disorders. Among the types of eye pathology considered are retinoblastoma, retrolental fibroplasia, congenital glaucoma, congenital cataracts, congenital strabismus, chlamydia oculogenitalis, orbital cellulitis, and eye injuries.…

Robb, Richard M.




Microsoft Academic Search

Friction blisters are one of the most common injuries an active individual can experience. They are usually a minor annoyance, generally requiring only simple first aid and a short period of limited activity. However, it is possible for blisters to develop into more serious problems such as cellulitis or sepsis (1). This article reviews the pathogenesis of blisters, examines factors

Joseph J. Knapik


Effect of the Raw Material Composition of Fabrics on the Limiting Oxygen Index (LOI).  

National Technical Information Service (NTIS)

The raw material composition of fabrics is one of the most important factors for LOI value. LOI value was determined in samples of varying composition composed of cellulose, protein, and synthetic fibers and their mixtures, based on ASTM D 2863-76. Cellul...

S. Jeler B. Ceric



Mucor circinelloides Was Identified by Molecular Methods as a Cause of Primary Cutaneous Zygomycosis  

Microsoft Academic Search

CASE REPORT A 90-year-old male presented to his primary-care physician with fever, fatigue, and lower-right-leg cellulitis following trauma to the leg. The trauma, which occurred about 1 month prior to presentation, was described by the patient as being \\

Peter C. Iwen; Lynne Sigler; Rhonda K. Noel; Alison G. Freifeld



Cathelicidin LL37 in Severe Streptococcus pyogenes Soft Tissue Infections in Humans  

Microsoft Academic Search

Severe soft tissue infections, such as necrotizing fasciitis and severe cellulitis, caused by group A streptococci (GAS) are rapidly progressing life-threatening infections characterized by massive bacterial loads in the tissue even late after the onset of infection. Antimicrobial peptides are important components of the innate host defense, and cathelicidins have been shown to protect against murine necrotic skin infections caused

Linda Johansson; Pontus Thulin; Parham Sendi; Erika Hertzen; Adam Linder; P. Akesson; Donald E. Low; Birgitta Agerberth; Anna Norrby-Teglund



Case report Combined sphenoid and frontal sinus aplasia accompanied by bilateral maxillary and ethmoid sinus hypoplasia  

Microsoft Academic Search

We describe CT scans of a case with bilateral aplasia of frontal and sphenoid sinuses with symmetrical hypoplasia of the ethmoid cellules and maxillary sinuses. This case appears to be first in the English-language literature with these combined findings. Paranasal sinuses are prone to a great diversity of anomalies. It is important for surgeons to be aware of variations that




Recurrent Bacteremia Caused by a \\  

Microsoft Academic Search

Helicobacter spp., except for Helicobacter cinaedi, have only rarely been reported in cases of septicemia. A patient with X-linked (Bruton's) agammaglobulinemia was found to have persistent sepsis with a Helicobacter- like organism despite multiple courses of antibiotics. His periods of sepsis were associated with leg swelling thought to be consistent with cellulitis. The organism was fastidious and required a microaerophilic




The accurate diagnosis and treatment of lipodermatosclerosis.  


Patients attending hospital expect to receive effective evidence-based treatment that improves health and minimises the risk of harm. Clinicians working in acute hospitals are often under pressured to treat people quickly and in such circumstances, some conditions can be misdiagnosed and inappropriately treated. This article uses a case study approach to illustrate the important differences in clinical presentation and treatment of acute and chronic lipodermatosclerosis and cellulitis. It also highlights the importance of clinicians receiving ongoing education so that they can improve their knowledge and provide appropriate care for older people. The article also recommends that national guidelines are developed to enable clinicians to differentiate between infective disorders such as cellulitis and venous disorders so that patients receive prompt effective evidence-based treatment. PMID:19543156

Nazarko, Linda


Radionuclide imaging in the evaluation of osteomyelitis and septic arthritis  

SciTech Connect

Despite controversy over its exact role, radionuclide imaging plays an important role in the evaluation of patients suspected of having osteomyelitis. The differentiation between osteomyelitis and cellulitis is best accomplished by using a three-phase technique using Tc-99m methylene diphosphonate (MDP). Frequently, it is necessary to obtain multiple projections and magnification views to adequately assess suspected areas. It is recommended that a Ga-67 or In-111 leukocyte scan be performed in those cases where osteomyelitis is strongly suspected clinically and the routine bone scan is equivocal or normal. Repeated bone scan after 48 to 72 h may demonstrate increased radioactivity in the case of early osteomyelitis with the initial photon-deficient lesion. In-111 leukocyte imaging is useful for the evaluation of suspected osteomyelitis complicating recent fracture or operation, but must be used in conjunction with clinical and radiographic correlation. The recognition of certain imaging patterns appears helpful to separate osteomyelitis from septic arthritis or cellulitis. 83 references.

Kim, E.E.; Haynie, T.P.; Podoloff, D.A.; Lowry, P.A.; Harle, T.S. (Univ. of Texas M.D. Anderson Hospital, Houston (USA))



Asymptomatic Wolff-Parkinson-White syndrome: incidental ECG diagnosis and a review of literature regarding current treatment  

PubMed Central

A 19-year-old male presented with periorbital cellulitis responsive to intravenous antibiotics. A routine ECG on admission showed slurred upstroke of the QRS complexes consistent with Wolff–Parkinson–White syndrome (WPW). He has never experienced any cardiac-related symptoms. Once the periorbital cellulitis resolved, he was referred to the specialist cardiology ablation clinic. He was counselled on the arrythmogenic risks of untreated WPW and the potential complications of radiofrequency catheter ablation (RFCA). He decided to go ahead with electrophysiological studies and RFCA, which took place successfully. This case highlights the importance of routine ECG in the diagnosis of asymptomatic WPW. The use of prophylactic ablation of asymptomatic WPW is controversial and should be considered on a case-specific basis.

Liu, Alexander; Pusalkar, Pawan



Establishing and interpreting an electrical circuit representing a TiO 2–WO 3 series of humidity thick film sensors  

Microsoft Academic Search

This paper reports the establishment and interpreting of an equivalent electrical circuit representing the humidity-sensitive electrical properties of TiO2–WO3 thick films. Prototype sensors have been prepared by depositing an emulsion of TiO2 and WO3 powders in acetone with cellulous glue onto an alumina substrate, by a spin coating technique using a low spreading speed (250rpm). Films were prepared with five

P. M. Faia; A. J. Ferreira; C. S. Furtado



Fractionation and characterization of polyadenylated RNA from broad bean meristematic root cells  

Microsoft Academic Search

Après extraction séquentielle au phénol des ARN totaux de cellules méristématiques de racine de Fêve, les ARN polyadénylés, fixés sur colonne de poly(U)-Sépharose, sont séparés en plusieurs populations par une élution thermique à 40° et 50° C. L'analyse structurale de ces fractions montre que si la taille du segment des poly(A) joue le principal rôle dans ce partage, d'autres caractéristiques

G. Trapy; A. Favre; R. Esnault



Recent Incarceration Linked to Cutaneous Injection-Related Infections Among Active Injection Drug Users in a Canadian Setting  

Microsoft Academic Search

Cutaneous injection-related infections (CIRI), such as abscesses and cellulitis, are the cause of a substantial burden of\\u000a morbidity and mortality among injection drug users (IDU). The possible contribution of exposure to correctional environments\\u000a to CIRI risk has not been fully investigated. Thus, we sought to test the possible relationship between incarceration and\\u000a CIRI using data from a community-based sample of

M.-J. Milloy; Evan Wood; Elisa Lloyd-Smith; Eric Grafstein; Mark Tyndall; Julio Montaner; Thomas Kerr



Plasmacytoid monocytes and dendritic cells link innate and acquired immunity  

Microsoft Academic Search

Riassunto. I monociti plasmacitoidi (PM), originariamente descritti dai patologi come cellule localizzate nell'area interfollicolare dei linfonodi umani, rappresentano una popolazione cellulare emergente nel panorama del sistema immunitario. I PM circolano tra sangue periferico, organi linfoidi e siti effettori dell'infiammazione, utilizzando meccanismi di migrazione specifici; essi risultano facilmente riconoscibili sulla base delle caratteristiche morfologiche e di un fenotipo distintivo CD3-, CD11c-,

F. Facchetti; W. Vermi



An outbreak of post-surgical wound infections due to Mycobacterium abscessus  

Microsoft Academic Search

An outbreak of post-operative wound infections due to Mycobacterium abscessus is described. During a 5-month period 45 post-surgical patients developed wound infection, manifested by wound breakdown,\\u000a cellulitis, and discharge and progressing slowly to suppuration and sinus formation. The majority (43\\/45) had undergone out-patient\\u000a operations, and 40 had had surgery in the inguinal region. The source of infection was identified as

R. Chadha; M. Grover; A. Sharma; A. Lakshmy; M. Deb; A. Kumar; G. Mehta



The introducer technique is the optimal method for placing percutaneous endoscopic gastrostomy tubes in head and neck cancer patients  

Microsoft Academic Search

Background  Percutaneous endoscopic gastrostomy (PEG) tubes are often placed in head and neck cancer patients to provide nutritional support,\\u000a but studies have found the complication rates to be higher than other subsets of patients who undergo PEG placement. Complication\\u000a rates as high as 50% have been reported, with the bulk of these complications being PEG site issues (i.e., cellulitis, abscess,\\u000a fascitis,

Jason M. Foster; Peter Filocamo; Hector Nava; Michael Schiff; Wesley Hicks; Nestor Rigual; Judy Smith; Thom Loree; John F. Gibbs



Optimal Auditing with Scoring Theory and Application to Insurance Fraud  

Microsoft Academic Search

Cet article établit une liaison entre la théorie de l'audit optimal et la méthodologie du scoring dans un contexte d'asymétrie d'information. L'application retenue concerne la fraude à l'assurance, mais la même approche peut être appliquée à d'autres activités qui utilisent le scoring. Nous montrons que la stratégie et l'audit optimal consistent à transmettre les demandes d'indemnité à une cellule antifraude

Georges Dionne; Florence Giuliano; Pierre Picard



Elements nerveux intracardiaques et innervation du myocarde  

Microsoft Academic Search

L'étude au microscope électronique des éléments nerveux intracardiaques et des rapports musculo-nerveux dans le coeur de rat nous a montré un certain nombre de particularités:1.Dans les ganglions nerveux du sulcus terminalis, on trouve des cellules particulières proches des éléments chémorécepteurs du corpuscule carotidien. Des cylindraxes renflés rappelant les corps de Herring se rencontrent prés de l'abouchement de l'aorte. Ils renferment

Sz. Virágh; A. Porte



Paramètres biologiques de réponse tardive des tissus sains aux rayonnements ionisants  

Microsoft Academic Search

Résumé  Par leur caractère irréver sible et leur impact sur la qualité de vie, les effets secondaires tardifs des tissus sains constituent\\u000a un facteur limitant de la radiothérapie. L’irradiation est à l’origine de dérè glements biologiques multiples aboutissant\\u000a à la destruction des cellules souches, à des atteintes vasculaires et à la constitution pro gressive d’une fibrose interstitielle\\u000a qui s’aggrave avec le

A. Braccini; M. Ozsahin; D. Azria



Hair and scalp disorders in ethnic populations.  


Human hair has been classified into 3 major groups, as determined by ethnic origin. In these populations, significant structural and biochemical variations of the hair follicle and shaft are seen, as well as unique hair grooming practices. These structural variations of the hair are closely linked to the common disorders of the hair and scalp, such as acquired trichorrhexis nodosa, seborrheic dermatitis, traction alopecia, central centrifugal cicatricial alopecia, dissecting cellulitis, frontal fibrosing alopecia, and pseudofolliculitis barbae. PMID:23652889

Rodney, Ife J; Onwudiwe, Oge C; Callender, Valerie D; Halder, Rebat M



Alterations des fonctions de reproduction chez les souris males deficientes en recepteur aux estrogenes  

Microsoft Academic Search

Resume  La délétion du récepteur aux estrogènes (estrogen receptor knock out i.e ERKO) chez la souris mâle conduit à la stérilité\\u000a suite à une déficience de la gamétogenèse associée à des altérations du comportement sexuel. En fonction de l’âge, le développement\\u000a testiculaire est de plus en plus anormal et les cellules germinales dégénèrent. Les taux circulants de gonadotropines et de\\u000a testostérone

K. S. Korach; J. Lindzey



[Management of limb lymphedema].  


Lymphedema results from impaired lymphatic transport with increased limb volume. Cellulitis is the main complication, but psychological or functional discomfort may occur throughout the course of lymphedema. Lymphedema management is based on complete decongestive physiotherapy (multilayer low stretch bandage, manual lymph drainage, skin care, exercises). First phase of treatment leads to a reduction of lymphedema volume. The second phase stabilizes the volume and is based on elastic compression. Resection surgery is a useful tool in external genitalia lymphedema. PMID:22296831

Vignes, S



Development of Specific Nested Oligonucleotide PCR Primers for the Streptococcus iniae 16S-23S Ribosomal DNA Intergenic Spacer  

Microsoft Academic Search

Streptococcus iniae is a cause of septicemia, meningoencephalitis, and death in farmed fish and of cellulitis in human beings. A set of nested oligonucleotide PCR primers that specifically amplified a 373-bp subunit from a variety of clinical isolates from farmed fish and human patients were constructed from a 524-bp consensus sequence of the S. iniae 16S-23S ribosomal DNA intergenic spacer.




Maximizing the photocurrent density in a p-n-p-n silicon multilayer solar cell  

Microsoft Academic Search

Résumé : Les cellules solaires multijonction occupent une place majeure dans le domaine de la conversion photovoltaïque de l'énergie solaire. Ces nouvelles structures présentent l'avantage d'une meilleure collecte des porteurs de charges générés par effet photovoltaïque en minimisant les pertes dues à leurs recombinaisons. En effet, en introduisant plusieurs jonctions dans la structure multicouches, tout porteur de charge (électron ou

A. Bouzidi; A. S. Bouazzi


Notes from the field: Contamination of alcohol prep pads with Bacillus cereus group and Bacillus species--Colorado, 2010.  


In October 2010, a child at The Children's Hospital (TCH) in Aurora, Colorado, with newly diagnosed leukemia developed clinical sepsis 24 hours after insertion of an implanted vascular access device. The child also developed extensive cellulitis at the insertion site, requiring surgical debridement, intensive care, antibiotics, prolonged wound management, and outpatient treatment. Cultures of the child's blood and tissue specimens grew Bacillus cereus. An investigation found neither breach of infection control procedures nor any violations of sterile surgical technique. PMID:21430639



Ion exchange properties of roots and ionic interactions within the root apoplasm: Their role in ion accumulation by plants  

Microsoft Academic Search

\\u000a Résumé  Lors de leur passage d’éléments nutritifs, en solution dans le sol, vers le mécanisme actif d’absorption, localisé a la surface\\u000a symplasmique, les ions, absorbés au plasmalemma des cellules de racine, doivent en premier lieu passer à travers les espaces\\u000a libres de la membrane cellulaire. Cet article discute les propriétés des racines au point de vue de l’échange de cations en

R. J. Haynes



Myroides odoratimimus soft tissue infection in an immunocompetent child following a pig bite: case report and literature review.  


Members of the genus Myroides are aerobic Gram-negative bacteria that are common in environmental sources, but are not components of the normal human microflora. Myroides organisms behave as low-grade opportunistic pathogens, causing infections in severely immunocompromised patients and rarely, in immunocompetent hosts. A case of Myroides odoratimimus cellulitis following a pig bite in an immunocompetent child is presented, and the medical literature on Myroides spp. soft tissue infections is reviewed. PMID:22846131

Maraki, Sofia; Sarchianaki, Emmanouela; Barbagadakis, Sophia


Autoimmune hemolytic anemia due to auto anti-N in a patient with sepsis.  


We describe a case of autoimmune hemolytic anemia (AIHA) due to anti-N in a young male patient with cellulitis. There have been several reports of anti-N in N positive individuals. But in all these reports, auto anti-N was mostly associated with underlying immunological conditions. We report here a case of auto anti-N in a patient of bacterial sepsis without any underlying immune disorder. PMID:22985536

Singh, Lakhvinder; Malhotra, Sheetal; Kaur, Gagandeep; Basu, Sabita; Kaur, Ravneet



Severe skin and soft tissue infections and associated critical illness  

Microsoft Academic Search

Skin and soft tissue infections (SSTIs) span a broad spectrum of clinical entities from limited cellulitis to rapidly progressive\\u000a necrotizing fasciitis, which may be associated with septic shock or a toxic shock-like syndrome. These infections may manifest\\u000a initially as pyodermas that then progress; alternatively, they may arise from metastatic spread of microorganisms from a distant\\u000a focus. Regardless of the source,

Donald C. Vinh; John M. Embil



Combined endovascular treatment of aorto-oesophageal fistula with mediastinitis.  


False aortic aneurysm is an uncommon complication after oesophageal perforation and results in a high rate of mortality. A 63-year-old patient presented with acute chest pain. Biochemical tests (cardiac enzymes) and electrocardiogram were normal. A thoracic and abdominal CT scan was performed, and showed a foreign body in the posterior mediastinum, with mediastinal cellulitis and a false aortic aneurysm. Surgical endovascular management was performed, with stenting of the thoracic aorta and oesophageal exploration. PMID:23042800

Berna, Pascal; Pequignot, Aurélien; De Temmerman, Pierre; De Dominicis, Florence



Radionucleotide scanning in osteomyelitis  

SciTech Connect

Radionucleotide bone scanning can be an excellent adjunct to the standard radiograph and clinical findings in the diagnosis of osteomyelitis. Bone scans have the ability to detect osteomyelitis far in advance of the standard radiograph. The sequential use of technetium and gallium has been useful in differentiating cellulitis and osteomyelitis. Serial scanning with technetium and gallium may be used to monitor the response of osteomyelitis to antibiotic therapy.

Sachs, W.; Kanat, I.O.



Temporomandibular joint involvement in familial mediterranean fever  

Microsoft Academic Search

Case 2. A 15-year-old girl of Jewish Sephardi origin had a history of recurrent cellulitis on the medial aspect of the ankles since 7 years of age. At age 12, she had recurrent episodes of chest pain and\\/or abdominal pain with fever. At age 14 years she underwent laparotomy and appendectomy because of signs of peritonitis. Histologically her appendix was

M. Mukamel; M. Mimouni



The Australian NHMRC Twin Registry: A resource for paediatric research  

Microsoft Academic Search

Case 2. A 15-year-old girl of Jewish Sephardi origin had a history of recurrent cellulitis on the medial aspect of the ankles since 7 years of age. At age 12, she had recurrent episodes of chest pain and\\/or abdominal pain with fever. At age 14 years she underwent laparotomy and appendectomy because of signs of peritonitis. Histologically her appendix was

J. L. Hopper



Syndromes myélodysplasiques: Mise au point  

Microsoft Academic Search

Résumé:  Les syndromes myélodysplasiques sont des affections hématologiques clonales dont la fréquence est croissante au-delà de 60\\u000a ans. Leur physiopathologie est complexe, associant une hyperapoptose des cellules médullaires et une instabilité génétique,\\u000a conduisant à une évolution fréquente vers une leucémie aigüe myéloblastique. (LAM) Plusieurs sous-groupes sont reconnus dans\\u000a les classifications FAB et OMS, et dans la classification pronostique IPSS, caractérisés par

C. Gardin; P. Fenaux



Orbital complications after aqueous drainage device procedures.  


A retrospective case series of 2 patients with orbital complications after tube shunt placement for glaucoma is reported. The first patient presented with limited motility and conjunctival injection in the setting of intraocular gas leakage in the superior orbit after previous vitreoretinal surgery. The second patient presented with multiple signs of orbital cellulitis. Both patients improved with intravenous antibiotics. Although rare, orbital complications may occur after glaucoma tube shunt surgery. PMID:15677956

Marcet, Marcus M; Woog, John J; Bellows, A Robert; Mandeville, John T; Maltzman, Jeffrey S; Khan, Jemshed



Increased Serum Levels of Epidermal Growth Factor in Children with Autism  

Microsoft Academic Search

The etiology of autism is unclear, however autism is considered as a multifactorial disorder that is influenced by neurological,\\u000a environmental, immunological and genetic factors. Growth factors, including epidermal growth factor (EGF), play an important\\u000a role in the celluler proliferation and the differentiation of the central and peripheral nervous system. In this study we\\u000a hypothesized that EGF may play a role

Elvan ??eri; Esra Güney; Mehmet F. Ceylan; Ay?egül Yücel; Arzu Aral; ?ahin Bodur; ?ahnur ?ener



Penile Crohn's disease resolved by infliximab.  


Crohn's disease is a chronic relapsing, granulomatous, and inflammatory bowel disorder. Variable extra-intestinal manifestations may occur, which include erythema nodosum, erythema multiforme, pyoderma gangrenosum, and other non-specific skin lesions. Here, we present a case of metastatic penile Crohn's disease without scrotal involvement, which was initially approached as a balanoposthitis with penile cellulitis, and completely treated with infliximab infusion in a short time. PMID:22841132

Lee, Yoon; Lee, Yoo Min; Kim, Mi Jin; Choe, Yon Ho



Current Status of Group A Streptococcal Vaccine Development  

Microsoft Academic Search

Group A streptococci (GAS) are ubiquitous human pathogens that cause a wide spectrum of clinical syndromes. The acute infections\\u000a range from uncomplicated pharyngitis, cellulitis, and pyoderma to necrotizing fasciitis, sepsis, pneumonia, and streptococcal\\u000a toxic shock syndrome. The non-suppurative sequelae that may follow GAS infections are acute rheumatic fever (ARF) and post-streptococcal\\u000a glomerulonephritis (PSGN). The burden of disease caused by GAS

James B. Dale


Orbital Inflammation Developing from Epidemic Keratoconjunctivitis in an Adult  

PubMed Central

Introduction We report a rare case of epidemic keratoconjunctivitis (EKC) that developed into an orbital inflammation in an adult. Case Presentation A 67-year-old Korean man, who had been diagnosed with EKC and treated for conjunctival injection and chemosis in the right eye for 4 days, was referred to Oculoplastics as orbital cellulitis was suspected. At the point of referral, clinical features such as decreased visual acuity, severe eyelid swelling, chemosis, follicles, corneal edema, limitations in lateral eye movement, and diplopia were observed in the right eye. Orbital cellulitis was suspected according to orbital computed tomography scan images, but there was no response to systemic antibiotics. Systemic steroid was administered instead, and then his symptoms and signs started to improve. The final diagnosis of this patient was orbital inflammation related to EKC based on the facts that there was no response to antibiotics, that he presented with contralateral symptoms and signs, that pseudomembrane formation occurred in both eyes, and that the symptoms resolved completely after 2 weeks. Conclusion Clinicians need to consider the possibility of orbital inflammation developing from EKC, even in an adult patient, and treat the patient properly if the EKC symptoms and signs, such as conjunctival injection and follicles, are accompanied with symptoms and signs similar to orbital cellulitis.

Kim, Sung In; Lee, Kyeong Wook



Anti-infective treatment in HIV-infected patients during perioperative period  

PubMed Central

Objective To investigate anti-infective treatments in HIV-infected surgical patients during the perioperative period. Methods A retrospective study of sepsis and surgical site infections (SSIs) was conducted in 266 HIV-infected patients. The patients were divided into 3 groups based on CD4+ T cells counts in the preoperative period: group A (0–199 cell/ul), group B (200–349 cell/ul) and group C ([greater than or equal to] 350 cell/ul). When the CD4 count was below 350 cells/uL, anti-retrovirus therapy was started. For patients whose preoperative CD4 counts were [less than or equal to] 200 cells/uL, preoperative antibiotic medication was started. Results Patients in group A were more likely to get sepsis than patients in the other two groups (p0.01). Among 82 patients with clean wounds, only one patient got SSIs. All patients with dirty wounds had acquired SSIs after surgery. There were only 6 patients dead at 30 days after surgery, a death rate of 2.3%. Sepsis appeared in 110 patients (41%). Conclusions Complete evaluation of surgical risk and suitable perioperative anti-infective treatment may lead to better outcome for HIV-infected surgical patients.



Blindness caused by septic superior ophthalmic vein thrombosis in a Lemierre Syndrome variant.  


A 65-year-old man presented with right facial cellulitis and right blindness. Enhanced CT and MRI showed right facial cellulitis involved with pterigopalatine fossa. Additionally, orbital cellulitis, superior ophthalmic vein thrombosis, and pulmonary multiple nodules were observed. (18)F-FDG PET/CT supported these findings. He was diagnosed with septic superior ophthalmic vein thrombosis accompanied with Lemierre Syndrome variant and was treated mainly by the administration of intravenous antibiotics. His symptoms and image findings improved after a few days of treatment, but the right visual loss has not recovered. Since septic superior ophthalmic vein thrombosis and Lemierre Syndrome both have life-threatening potential, early diagnosis and appropriate treatment are important and may contribute to reduce the incidence of severe complications. Septic superior ophthalmic vein thrombosis accompanied with Lemierre Syndrome is exceeding rare, and this case is the first report of blindness in Lemierre Syndrome. A literature review and discussion of septic superior ophthalmic vein thrombosis and Lemierre Syndrome are included. PMID:23084837

Akiyama, Kosuke; Karaki, Masayuki; Samukawa, Yasushi; Mori, Nozomu



[Skin and soft-tissue infections in hospitalized patients: Epidemiology, microbiological, clinical and prognostic factors.  


INTRODUCTION: Skin and soft-tissue infections (SSTIs) are a frequent cause of consultation in emergence services, and complicated cases require hospitalization. However there are few data in our setting about the clinical characteristics of these infections. MATERIAL AND METHODS: A retrospective review of hospital admitted patients with a diagnosis of folliculitis, cellulitis, erysipelas, abscesses, hidradenitis, furuncle, impetigo, fasciitis and Fournier's gangrene. Cases were extracted from the data base of diagnostic codes of the Archive and Clinical Documentation Department of Son Llàtzer Hospital from January 2002 to November 2011. RESULTS: We studied 996episodes in 841hospitalized patients with any diagnosis of SSTIs. Cellulitis/erysipelas (66.7%) was the most frequently diagnosed condition, with 77% of all SSTIs being community acquired, and the majority of patients had comorbidities, mainly diabetes (33%) and heart failure (17.7%). The most frequent isolated microorganism was S.aureus (35.1%), in 19 (12.9%) cases with methicillin-resistance (MRSA), 84.2% of them were nosocomial or health care acquired. Monotherapy with aminopenicillin with clavulanic acid was the empiric treatment most frequently used (35.5%). New antibiotics for Gram-positive cocci (linezolid, daptomycin, and tigecycline) were used in patients with comorbidities that presented more complications (P<.001) and more risk of mortality (P=.001). During admission 10.9% of patients died, but only in 2.7% of them mortality was related to the SSTIs. CONCLUSIONS: SSTIs attended most frequently in hospitalized patients are mainly cellulitis/erysipela, the majority community acquired. MRSA infections are mainly health care related. Use of new antibiotic for Gram-positive cocci was limited. PMID:23683754

Raya-Cruz, Manuel; Ferullo, Ignacio; Arrizabalaga-Asenjo, María; Nadal-Nadal, Antonio; Díaz-Antolín, María Paz; Garau-Colom, Margarita; Payeras-Cifre, Antonio



Use of electronic health record data to identify skin and soft tissue infections in primary care settings: a validation study  

PubMed Central

Background Epidemiologic studies of skin and soft tissue infections (SSTIs) depend upon accurate case identification. Our objective was to evaluate the positive predictive value (PPV) of electronic medical record data for identification of SSTIs in a primary care setting. Methods A validation study was conducted among primary care outpatients in an academic healthcare system. Encounters during four non-consecutive months in 2010 were included if any of the following were present in the electronic health record: International Classification of Diseases, Ninth Revision (ICD-9) code for an SSTI, Current Procedural Terminology (CPT) code for incision and drainage, or a positive wound culture. Detailed chart review was performed to establish presence and type of SSTI. PPVs and 95% confidence intervals (CI) were calculated among all encounters, initial encounters, and cellulitis/abscess cases. Results Of the 731 encounters included, 514 (70.3%) were initial encounters and 448 (61.3%) were cellulitis/abscess cases. When the presence of an ICD-9 code, CPT code, or positive culture was used to identify SSTIs, 617 encounters were true positives, yielding a PPV of 84.4% [95% CI: 81.8–87.0%]. The PPV for using ICD-9 codes alone to identify SSTIs was 90.7% [95 % CI: 88.5–92.9%]. For encounters with cellulitis/abscess codes, the PPV was 91.5% [95% CI: 88.9–94.1%]. Conclusions ICD-9 codes may be used to retrospectively identify SSTIs with a high PPV. Broadening SSTI case identification with microbiology data and CPT codes attenuates the PPV. Further work is needed to estimate the sensitivity of this method.



Orbital infarction syndrome after transcanalicular dacryocystorhinostomy with diode laser.  


Orbital infarction syndrome is a rare but devastating disorder resulting in sudden visual loss. A patient with orbital infarction syndrome due to orbital cellulitis after transcanalicular dacryocystorhinostomy with diode laser is described. A 55-year-old woman presented 3 days after transcanalicular dacryocystorhinostomy. Initial examination revealed significant eyelid swelling, marked proptosis, total ophthalmoplegia, and no light perception in the right eye. Fundus examination revealed ophthalmic artery occlusion. The clinical findings of the patient were consistent with orbital infarction syndrome. Clinical findings improved with antibiotic therapy, but visual acuity did not change. PMID:23092132

Yeniad, Baris; Tuncer, Samuray; Kir, Nur; Bilgin, Lale Kozer



Kodamaea ohmeri isolate from two immunocompromised patients: first report in Italy.  


Kodamaea ohmeri is an unusual yeast-form fungus that has recently been identified as an important aetiological agent of fungaemia, endocarditis, cellulitis, funguria and peritonitis in immunocompromised patients. We present two new isolated of K. ohmeri. The microorganisms were identified by CHROMagar Candida medium, VitekII system and API ID32C. Biochemical identification of the two yeast isolates was confirmed by sequence analysis of the 26S ribosomal DNA. Antifungal susceptibility testing done by Sensititre YeastOne showed that the isolates were susceptible to amphotericin B, voriconazole and itraconazole. This work is the first report of isolation of K. ohmeri in immunocompromised patients in Italy. PMID:22882303

Santino, I; Bono, S; Borruso, L; Bove, M; Cialdi, E; Martinelli, D; Alari, A



Atlas of computerized blood flow analysis in bone disease.  


The role of computerized blood flow analysis in routine bone scanning is reviewed. Cases illustrating the technique include proven diagnoses of toxic synovitis, Legg-Perthes disease, arthritis, avascular necrosis of the hip, fractures, benign and malignant tumors, Paget's disease, cellulitis, osteomyelitis, and shin splints. Several examples also show the use of the technique in monitoring treatment. The use of quantitative data from the blood flow, bone uptake phase, and static images suggests specific diagnostic patterns for each of the diseases presented in this atlas. Thus, this technique enables increased accuracy in the interpretation of the radionuclide bone scan. PMID:6653012

Gandsman, E J; Deutsch, S D; Tyson, I B



Brown recluse spider bite to the upper lip.  


Brown recluse spiders are predominantly found in south central United States. Their bites usually cause mild self-limiting reactions, although localized tissue necrosis and rare systemic, potentially fatal, envenomations are known to occur. Herein, we report an atypical presentation of a brown recluse bite in a 20 year old female who was admitted to the intensive care unit due to angioedema and cellulitis. We photographically document the bite site for twenty-four hours following envenomation. She received glucocorticoids, antihistamines, antibiotics and dapsone while hospitalized and was subsequently discharged with complete resolution of symptoms without the development of tissue necrosis or scarring. PMID:22479977

Dare, Ryan K; Conner, Kelly B; Tan, Poliana C; Hopkins, Robert H



Human Dirofilaria repens Infection in Romania: A Case Report  

PubMed Central

Human dirofilariasis is a zoonotic infectious disease caused by the filarial nematodes of dogs Dirofilaria repens and Dirofilaria immitis. Depending on the species involved, human infections usually manifest as one cutaneous or visceral larva migrans that forms a painless nodule in the later course of disease. Dirofilariae are endemic in the Mediterranean, particularly in Italy. They are considered as emerging pathogens currently increasing their geographical range. We present one of the few known cases of human dirofilariasis caused by D. repens in Romania. The patient developed unusual and severe clinical manifestations that mimicked pathological conditions like cellulitis or deep venous thrombosis.

Popescu, Ioana; Tudose, Irina; Racz, Paul; Muntau, Birgit; Giurcaneanu, Calin; Poppert, Sven



Bilateral parotid enlargement following snake bite: A rare sign  

PubMed Central

Snakebite is a common medical emergency in India. Unusual complications may occur after viper bite. Bilateral parotid enlargement after viper bite is a rare entity. An 18-year old gentleman presented to our hospital with history of viper bite. On examination he had cellulitis of right lower limb. He developed swelling of both the parotid glands 12 h after admission. He developed coagulopathy, acute renal failure and died within 48 h of hospital admission. Development of parotid swelling after snake bite is associated with poor prognosis. This case is found worth reporting as it is an unusual complication having prognostic value.

Deepak, Madi; Basavaprabhu, Achappa; Ramapuram, John T; Nithyananda, Chowta; Mahalingam, Soundarya



Improved early diagnosis of acute inflammatory skeletal-articular diseases in children: A two-radiopharmaceutical approach  

SciTech Connect

The febrile child with a painful bone or joint still presents a difficult pediatric diagnostic problem. Acute hematogenous osteomyelitis, septic arthritis, and cellulitis are the most common causes of this symptom. Thirty-seven patients with these disorders were studied. Because findings from technetium-99m phosphate bone scans and roentgenograms are often normal in patients in the early stages of acute hematogenous osteomyelitis, children suspected of having this disorder were tested using gallium-67 citrate scans in addition to the other diagnostic procedures. The increased diagnostic accuracy of this approach over that of bone scan and roentgenogram studies alone was observed in the children with fever and bone or joint pain.

Handmaker, H.; Giammona, S.T.



Rhino-orbito-cerebral mucormycosis in patients with diabetic ketoacidosis.  


Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. The most common predisposing risk factor for mucormycosis is diabetes mellitus. Rhino-orbito-cerebral mucormycosis is the most common form in diabetic patients and is characterized by paranasal sinusitis, ophthalmoplegia with blindness, and unilateral proptosis with cellulitis, facial pain with swelling, headache, fever, rhinitis, granular or purulent nasal discharge, nasal ulceration, epistaxis, hemiplegia or stroke, and decreased mental function. Diabetic ketoacidosis is the most common and serious acute complication of diabetic patients. We herein report 2 cases of fatal rhino-orbito-cerebral mucormycosis in a patient with diabetic ketoacidosis. PMID:23524816

Gen, Ramazan; Horasan, Elif ?ahin; Vayso?lu, Yusuf; Arpaci, Rabia Bozdo?an; Ersöz, Gülden; Özcan, Cengiz



Acute complications of tattooing presenting in the ED.  


Permanent decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce the permanent design. Despite improved hygiene in the tattoo parlors of Western countries, this procedure still carries risk. Various complications may occur right after tattooing, from benign complications such as transient limb edema, palpable lymph nodes, and contact eczema, to more severe ones such as the inoculation of virulent microorganisms into the dermis, potentially life-threatening cellulitis, and necrotizing fasciitis or cutaneous vasculitis. This review focuses specifically on the complications that occur within the first month of tattooing that emergency physicians may have to manage. PMID:22944541

Kluger, Nicolas



Skin and soft tissue infections.  


The approach to common skin and soft tissue infections (SSTIs) was previously well understood. However, the recent emergence of community-associated methicillin resistant Staphyloccocus aureus as a common pathogen has changed the epidemiology of these infections and has led clinicians to alter their practice and treatment of SSTI. This article discusses the present epidemiology of SSTI and community-acquired methicillin-resistant Staphylococcus aureus, evidence-based approach to incision and drainage, the utility of adjuvant antibiotic therapy after abscess drainage, and current antimicrobial approach to cellulitis and nondrained SSTIs. Methods to reduce transmission and recurrence of SSTI through decolonization strategies are also discussed. PMID:24093896

Mistry, Rakesh D



Dermatitis cruris pustulosa et atrophicans--a frequent but poorly understood tropical skin condition--a case report from Burkina Faso.  


Dermatitis cruris pustulosa et atrophicans (DCPA) is a benign inflammatory skin disease of the younger population in the tropics. Although this pustular skin condition of particular topography is frequently seen by dermatologists in tropical countries, its origin remains unknown. We report the case of a young woman with DCPA associated with prurigo nodularis. A bacterial origin has not been demonstrated in this case. Histology showed an intraepidermal neutrophilic pustule with dermal and subcutaneous infiltration by neutrophils and eosinophils forming flame figures. Different pathogenic hypotheses are discussed with special regard to a potential relationship between DCPA and eosinophilic cellulitis. PMID:18412864

Bens, Guido; Franck, Frédéric; Diatto, Georges; Preney, Laure; Darie, Hervé; Géniaux, Marc



Carcinome neuroendocrine du sein: ? propos d'un cas et revue de la litt?rature  

PubMed Central

Le carcinome neuroendocrine primitif du sein est une tumeur rare qui a été reconnue par la dernière édition de la classification OMS du cancer du sein publiée en 2003. Le diagnostic est évoqué sur des critères morphologiques et confirmé par l'expression des marqueurs neuroendocrines (chromogranine et synaptophysine) par plus de 50% des cellules tumorales. Nous rapportons un nouveau cas de carcinome neuroendocrine primitif du sein, et à travers une revue de la littérature, nous détaillons les aspects épidémiologiques, morphologiques et immuno-histochimiques de cette tumeur rare.

El Fatemi, Hinde; Hammas, Nawal; Moumna, Kaoutar; Bedahou, Mouhcine; Mellas, Nawfel; Mesbahi, Omar



Critical care of the morbidly obese in disaster.  


The prevalence of obesity in the United States is increasing, with extreme morbid obesity of body mass index greater than 40 increasing twice as fast as obesity in general. With the increased weight comes an increased risk of comorbidities, including type 2 diabetes mellitus, cardiovascular disease, respiratory problems such as obstructive sleep apnea or restrictive lung disease, skin disorders such as intertrigo and cellulitis, and urinary incontinence. Thus, patients exposed to a variety of disasters not only are increasingly overweight but also have an associated number of coexistent medical conditions that require increased support with medical devices and medications. This article focuses on management of the morbidly obese patients during disasters. PMID:20970061

Geiling, James



A fatal case of Vibrio vulnificus presenting as septic arthritis.  


Vibrio vulnificus is an invasive gram-negative bacillus that may cause necrotizing cellulitis, bacteremia, and/or sepsis. Although V vulnificus infection is uncommon, it is frequently fatal and is usually attributed to ingestion of raw shellfish or traumatic exposure to a marine environment; patients are also often found to have a hepatic disorder (cirrhosis, alcohol abuse, or hemochromatosis) or an immunocompromised health status, and most commonly present with septicemia or a wound infection. We describe a patient who presented with septic arthritis as the first clinical manifestation of a V vulnificus infection. The organism was subsequently identified in a synovial fluid aspirate. PMID:11718594

Johnson, R W; Arnett, F C



Necrotizing soft-tissue infections in obstetric and gynecologic patients.  


For the clinician, necrotizing soft-tissue infections have remained a daunting opponent since the first writings on the subject over 2000 years ago. Early disease may be incorrectly diagnosed as cellulitis, and this delay in correctly diagnosing and expeditiously proceeding to radical surgical debridement may lead to a high degree of mortality. Although several inciting events and risk factors have been described that allow for the development and progression of this disease, the diagnosis is still made clinically. Only aggressive surgical management in combination with broad-spectrum antibiotics will offer a chance at improving patient outcomes. PMID:23090456

Faro, Sebastian; Faro, Jonathan P



[Persistent swelling after flushing of an abscess with Octenisept®].  


We report the case of a long-lasting cutaneous side effect after inappropriate use of Octenisept® solution (containing octenidine and phenoxyethanol). Following lavage of an abscess in the inguinal region, a painful erythematous induration mimicking cellulitis persisted for several months. Manual lymphatic drainage considerably improved the symptoms. Octenisept® shows considerable tissue toxicity in vivo including - but not restricted to - blood vessel damage. Deterioration of endothelial cells followed by oedema and continued tissue damage can be seen histologically. Despite the fact that there is a circular letter issued by the manufacturer as well as a boxed warning on the bottles, the awareness to avoid this misuse of Octenisept® is still lacking. PMID:22101779

Bauer, B; Majic, M; Rauthe, S; Bröcker, E-B; Kerstan, A



[Proliferative vitreoretinopathy treated with daunorubicin].  


Nine eyes with severe proliferative vitreoretinopathy underwent vitrectomy and infusion of Daunorubicin to prevent reproliferation. In 5 eyes (56%) the retina was reattached. In 4 eyes redetachment occurred because of reproliferation or incomplete sealing of the break. After a second vitrectomy, complete reattachment of the retina was obtained eventually in all eyes including one eye with silicone oil tamponade. As postoperative complications, conjunctival dehiscience occurred in 3 eyes. In two of the 3 eyes scleral buckling occurred, and orbital cellulitis occurred in one eye. Daunorubicin seemed to be effective to suppress reproliferation, but care should be taken to avoid postoperative complications. PMID:9284621

Inoue, M; Hirakata, A; Miki, D; Horie, E; Yata, K; Hida, T



Infections Acquired inClinical Laboratories inUtah  

Microsoft Academic Search

infections per1,000 employees. Infections, inorderoffrequency, included hepatitis B (clinical cases), shigellosis, pharyngitis, cellulitis, tuberculosis (skin test conversion), conjunctivitis, andnon-A, non-Bhepatitis. One-half oflarge laboratories (over 25employees), butonly12%ofsmaller laboratories, reported infections. Theannual incidence, however, atsmaller laboratories was more thanthree timesgreater thanatlarge laboratories (5.0 versus1.5per1,000; P< 0.05, chi-square test). Microbiologists wereatgreatest risk ofinfection, with an incidence ofalmost 1%,followed bygeneralists andphlebotomists. Shigellosis was acquired



Fatal septicemia caused by Helicobacter infection in a pancake tortoise (Malacochersus tornieri).  


Bacteria of the genus Helicobacter are associated with disease in humans and animals. Reports of infection in reptiles are very limited. In the present study, pathological findings and molecular characterization are reported for a Helicobacter species associated with septicemia in a pancake tortoise (Malacochersus tornieri). Disseminated infection resulted in regional cellulitis and edema of the head and neck, and pericarditis. Spiral bacteria were identified in cytological preparations and Warthin-Starry-stained sections of pathological lesions. Amplification of partial sequence of the 16S ribosomal gene using polymerase chain reaction identified the organism as Helicobacter and suggest that it is a novel species. PMID:20622247

Stacy, Brian A; Wellehan, James F X



Animal Models Commonly Used to Study Quorum-Sensing Inhibitors  

Microsoft Academic Search

\\u000a Multiple animal models exist for the study of biofilm infections and\\u000a their inhibitors in vivo. The infection models described in this chapter range\\u000a from the simple nematode-killing and amoeba-plate-killing assays, to models\\u000a with more relevance to human disease like the pulmonary and cellulitis\\u000a infection models in mice, the graft prosthesis, and the central venous\\u000a catheter infection models in rats, and

Naomi Balaban; Michael Givskov; Thomas Bovbjerg Rasmussen; Andrea Giacometti; Oscar Cirioni


Computed tomographic detection of sinusitis responsible for intracranial and extracranial infections  

SciTech Connect

Computed tomography (CT) is now used extensively for the evaluation of orbital, facial, and intracranial infections. Nine patients are presented to illustrate the importance of detecting underlying and unsuspected sinusitis. Prompt treatment of the sinusitis is essential to minimize the morbidity and mortality associated with complications such as brain abscess, meningitis, orbital cellulitis, and osteomyelitis. A review of the literature documents the persistence of these complications despite the widespread use of antibiotic therapy. Recognition of the underlying sinusitis is now possible with CT if the region of the sinuses is included and bone-window settings are used during the examination of patients with orbital and intracranial infection.

Carter, B.L.; Bankoff, M.S.; Fisk, J.D.



Ultrasonography of the extremities and pelvic girdle and correlation with computed tomography  

SciTech Connect

Ultrasonography was performed on 54 patients with lesions of the extremities and pelvic girdle. Computed tomography (CT) was employed in 8 patients. Focal space-occupying lesions such as tumors, abscesses, hematomas, aneurysms, and popliteal cysts (dissecting or otherwise) were delineated by ultrasound and their extent defined. Differentiation from diffuse changes such as lymphedema, cellulitis, or phlebitis and diagnosis of aneurysms were possible. Popliteal cysts were ususally quite characteristic, while correlation with the clinical features suggested the correct diagnosis in the case of the other lesions. CT correlated well with ultrasound, except for one tumor of the forearm which was not shown by CT.

Yeh, H.C.; Rabinowitz, J.G.



Radionuclide evaluation of nonmalignant bone disorders  

SciTech Connect

Recent advances in nuclear imaging have improved the noninvasive evaluation of patients with nonmalignant bone disorders. When bone scanning agents are combined with bone marrow scanning agents and gallium-67 scintigraphy, a more accurate diagnosis can be obtained. By selecting the appropriate imaging sequence, it is often possible to distinguish cellulitis from underlying osteomyelitis. In patients with total hip replacements, it may be possible to separate postsurgical changes from prosthetic loosening or infection. Stress fractures in joggers may be detected by radionuclide bone scintigraphy before radiographs become abnormal. These nuclear imaging procedures can be done in most hospitals.

Winzelberg, G.G.



Necrotizing Fasciitis - report of ten cases and review of recent literature.  


Necrotizing fasciitis is an uncommon disease that results in gross morbidity and mortality if not diagnosed and treated in its early stages. At onset, however, it is difficult to differentiate from other superficial skin conditions such as cellulitis. Family physicians must have a high level of suspicion and low threshold for surgical referral when confronted with cases of pain, fever, and erythema. We present ten cases of necrotizing fasciitis managed in a provincial secondary hospital in Oman over 3 years ago. A review of recent literature is also presented. PMID:23904882

Al Shukry, S; Ommen, J



Aspects électrochimiques de l'essai accéléré de perméabilité aux ions chlorures  

Microsoft Academic Search

Résumé  Cet article décrit les aspects électrochimiques de l'essai accéléré de perméabilité aux chlorures; il souligne le rôle de\\u000a la tension appliquée à la cellule et celui de la résistance électrique du béton. Ces deux paramètres déterminent les potentiels\\u000a d'électrodes et conditionnent les réactions électrochimiques qui sont susceptibles de s'y développer. Dans les conditions\\u000a opératoires classiques de l'essai, l'électrolyse de l'eau

W. Prince; J.-P. Ollivier; O. Truc



Bilateral parotid enlargement following snake bite: A rare sign.  


Snakebite is a common medical emergency in India. Unusual complications may occur after viper bite. Bilateral parotid enlargement after viper bite is a rare entity. An 18-year old gentleman presented to our hospital with history of viper bite. On examination he had cellulitis of right lower limb. He developed swelling of both the parotid glands 12 h after admission. He developed coagulopathy, acute renal failure and died within 48 h of hospital admission. Development of parotid swelling after snake bite is associated with poor prognosis. This case is found worth reporting as it is an unusual complication having prognostic value. PMID:23593596

Deepak, Madi; Basavaprabhu, Achappa; Ramapuram, John T; Nithyananda, Chowta; Mahalingam, Soundarya; Kanchan, Tanuj



Gas gangrene infection of the eyes and orbits.  

PubMed Central

The literature on Clostridium perfringens infections is reviewed up to 1983. An additional case is reported with bilateral clostridial infections of the eye and orbit. One eye followed the classical course of relentless panophthalmitis, amaurosis, and orbital cellulitis ending in enucleation. The second eye contained intracameral mud and gas bubbles that were removed by vitrectomy instrumentation. Subsequent removal of the toxic cataract resulted in a final aided visual acuity of 6/18, N8. This is the third report of a retained globe, and we believe the only known case where the patient was left with useful vision. Images

Crock, G W; Heriot, W J; Janakiraman, P; Weiner, J M



Imaging of the diabetic foot diagnostic dilemmas.  


Multiple diagnostic imaging modalities are available and beneficial for the evaluation of the diabetic foot. There is not yet "one best test" for sorting out the diagnostic dilemmas commonly encountered. The differentiation of cellulitis alone from underlying osteomyelitis and the early detection of abscesses remain important diagnostic goals. Equally important, differentiation of osteomyelitis and neuroarthropathy remains a difficult job. This is often compounded by postoperative diabetic foot states status after reconstruction. Diagnostic evaluation often involves multiple studies that are complementary and that include conventional radiography, computed tomography, nuclear medicine scintigraphy, magnetic resonance imaging, ultrasonography, and positron emission tomography. PMID:20966452

Loredo, Rebecca; Rahal, Andres; Garcia, Glenn; Metter, Darlene



Reactions to small pox vaccine in naïve and previously-vaccinated individuals.  


Two hundred health care workers in England and Wales were vaccinated with the Lister/Elstree strain of the vaccinia virus, and completed health diaries for 21 days or until the lesion had scabbed over. Pain and temperature were measured daily, and all other symptoms recorded freehand by the vaccinee. One hundred and forty two (71%) vaccinees reported pain, of which 25% considered it to be moderate or severe; 32 vaccinees (16%) recorded a temperature of >37.7 degrees C, two of which exceeded 39 degrees C. Other, mainly trivial, adverse events were common; itch was reported in 72%, erythema in 27%, axillary pain or lymphadenopathy in 38%, malaise or flu-like symptoms in 40% and headache in 23%. The incidences of minor adverse events were lower in re-vaccinees, compared with naïve vaccine recipients, significantly so in the case of erythema and general malaise (p=0.001 and 0.006, respectively), perhaps reflecting pre-existing immunity. Major adverse events occurred in two vaccinees (hospital admission, one with cellulitis and one with headache and possible encephalitis), and a further five were treated with antibiotics for local cellulitis. This is the first study to report results derived from active follow-up by diaries in recipients of the Lister/Elstree strain of vaccinia, and to document reductions in trivial adverse events in re-vaccinees. PMID:15916840

Auckland, Cressida; Cowlishaw, Alexandra; Morgan, Dilys; Miller, Elizabeth



Necrotizing soft-tissue infections in the feet of patients with diabetes: outcome of surgical treatment and factors associated with limb loss and mortality.  


The aim of this study was to analyze the outcomes of treatment of necrotizing soft-tissue infections (NSTIs) in the feet of diabetic patients and to determine factors associated with limb salvage and mortality. A retrospective study of a consecutive series of 145 diabetic patients suffering from NSTIs treated in the Diabetic Foot Unit, La Paloma Hospital was done. NSTIs were classified as necrotizing cellulitis if it involved the subcutaneous tissue and the skin, as necrotizing fasciitis if it involved the deep fascia, and as myonecrosis in those cases where muscular necrosis was present. In the necrotizing cellulitis group (n = 109), 8 (7.3%) major amputations were performed. In the necrotizing fasciitis group (n = 25), 13 (52%) major amputations were undertaken. In the myonecrosis group (n = 11), 6 (54.5%) major amputations were performed. Predictive variables related to limb loss were fasciitis (OR = 20, 95% CI = 3.2-122.1) and myonecrosis (OR = 53.2, 95% CI = 5.1-552.4). Predictive variables of mortality were age >75 years (OR = 10.3, 95% CI = 1.9-53.6) and creatinine values >132.6 micromol/L (OR = 5.8, 95% CI = 1.1-30.2). NSTIs of the foot are an important cause of morbidity and mortality in diabetic patients.When fascia and/or muscle are involved, there are significant risks of major amputation. PMID:19703949

Aragón-Sánchez, Javier; Quintana-Marrero, Yurena; Lázaro-Martínez, Jose L; Hernández-Herrero, Maria J; García-Morales, Esther; Beneit-Montesinos, Juan V; Cabrera-Galván, Juan J



[Children's soft tissue infections in tropical countries. Prospective study in Mayotte].  


In France and Europe, soft tissue infections are secondary to chickenpox infection. In tropical countries, soft tissue infections seem to be different and are more frequent. We conducted a prospective and descriptive study in children hospitalised for cellulitis. We studied characteristics of our population and we tried to individualize risk factors for deep soft tissue infections. 54 children were included over a six-month period. Blood cultures were positive in 10% and local culture in 62%. Pathogenic organisms to be found, were first Staphylococcus aureus (78%) and secondly alpha-haemolytic streptococcus. Average rate hospitalisation was 4.5 days (1-28). Despite intravenous antibiotherapy, more than one third of patients had had a deep soft tissue infection (myositis, abscess, or arthritis). As regards the overall population, deep soft tissue infections associated with cellulitis were more frequent in children over six. Association with arthritis was found only in children under two. Severe malnutrition seems to be a notable risk factor for myositis. Soft tissue infections are still frequent in tropical countries. Deep soft tissue infections are encountered in more than one third of the cases, specially in children over six, and with Staphylococcus aureus. These results justify a systematic hospitalisation. If severe malnutrition is present, association with myositis should be suspected. PMID:19739411

Runel-Belliard, C; Collet, L; Hebert, J-C



Current hypotheses on synergistic microbial gangrene.  


We have reviewed spreading infections of the dermis, with special reference to the importance of synergy in their causation. Evidence for this is accumulating from both clinical studies and from studies in laboratory animals. Necrotizing fasciitis (rapid spread over 24 h) can be caused by beta-haemolytic streptococci, sometimes with Staphylococcus aureus, or by mixed infections of aerobes and anaerobes, often of gut origin. Animal studies provide good evidence that S. aureus can potentiate the beta-haemolytic streptococcal infection in necrotizing fasciitis. There is also evidence that mixtures of aerobes and anaerobes can act synergistically, but animal models for necrotizing fasciitis have not been developed. Anaerobic cellulitis (variable rate of spread from hours to days) can be caused by mixed aerobes and anaerobes or by mixed clostridia. Animal studies provide good evidence for synergy in the former. Meleney's synergistic postoperative gangrene (slow spread over weeks) may be cutaneous amoebiasis: the animal model of Brewer and Meleney relates to the more rapid infections of anaerobic cellulitis. PMID:2182177

Kingston, D; Seal, D V



A Case of Elephantiasis Nostras Verrucosa  

PubMed Central

Elephantiasis nostras verrucosa (ENV) is a rare clinical condition associated with chronic non-filarial lymphedema caused by bacterial or non-infectious lymphatic obstruction. A variety of etiologies, including infection, tumor obstruction, trauma, radiation, chronic venous stasis, congestive heart failure, and obesity, can lead to chronic lymphatic obstruction and edema. Mossy papules, plaques, and cobblestone-like nodules are clinically impressive features of ENV, but biopsy reveals only moderately abnormal findings such as pseudoepitheliomatous hyperplasia, dilated lymphatic spaces, fibrous tissue hyperplasia, and chronic inflammation. We present a case of ENV in a 67-year-old man with a 10-year history of multiple nodules and verrucous plaques on both feet. Microbiology ruled out a filarial infection. Nodule biopsy revealed pseudoepitheliomatous hyperplasia, marked dermal fibrosis, and a chronic inflammatory infiltrate. No evidence of carcinoma was identified. Both venous stasis and recurrent cellulitis could contribute to the dermal fibrotic changes of the lesions. However, before the recurrent cellulitis, he did not have any nodular lesions on his feet despite a 10-year history of venous disease. Therefore, this case suggests that venous stasis alone cannot produce the fibrotic nodular lesions of ENV.

Yang, Yun-Seok; Ahn, Jae-Jun; Haw, Sik; Shin, Min-Kyung



An improved directional growth apparatus for liquid crystals: applications to thermotropic and lyotropic systems  

NASA Astrophysics Data System (ADS)

We have built a directional growth apparatus adapted for the study of thermotropic or lyotropic liquid crystals. This cell allows us to work under inert gas, to orient the sample from outside with respect to the temperature gradient, and to measure the front temperature within 0.1°C. Three applications are described. The first deals with the growth of a monocrystal of pivalic acid when the easy growth axis makes an angle with the heat flow direction. The second experiment is concerned with the fast growth of a discotic liquid crystal and the measurement of the molecular attachment kinetic coefficient at the interface between the columnar hexagonal mesophase and the isotropic liquid. A dynamical anchoring transition between domains of planar and homeotropic orientation will be also described. The last example focuses on the growth of a hexagonal phase of a water-surfactant binary mixture and the first observation of the Mullins-Sekerka instability in a lyotropic system. Nous avons construit une cellule de croissance directionnelle adaptée à l'étude des cristaux liquides thermotropes ou lyotropes. Cette cellule permet de travailler en atmosphère inerte, d'orienter l'échantillon de l'extérieur par rapport au gradient de température, et de mesurer la température du front à 0.1°C près. Trois exemples d'application sont décrits. Le premier porte sur la croissance d'un monocristal d'acide pivalique quand l'axe de croissance facile des cellules fait un angle avec la direction du flux de chaleur. La seconde expérience porte sur la croissance rapide d'un cristal liquide discotique et la mesure du coefficient cinétique d'attachement moléculaire à l'interface entre la mésophase colonnaire hexagonale et le liquide isotrope. Une transition d'ancrage dynamique entre des domaines d'orientations planaire et homéotrope sera également décrite. Le dernier exemple porte sur la croissance d'une phase hexagonale d'un mélange binaire eau-surfactant et la première observation de l'instabilité de Mullins-Sekerka dans un système lyotrope.

Oswald, P.; Moulin, M.; Metz, P.; Géminard, J. C.; Sotta, P.; Sallen, L.



Autoderm: an alternative bioprosthetic for breast reconstruction.  


The widespread use of bioprosthetic mesh in breast reconstruction has revealed an increased risk of seroma and infection, and a high financial cost. This study introduces a technique that mitigates these shortcomings using an autologous dermal graft (Autoderm). Indications, operative technique, and 1-year outcomes are reviewed. Thirty-six breasts in 21 patients underwent six unilateral and 15 bilateral, implant-based breast reconstructions with Autoderm. Mean follow-up was 365 days (range, 273 to 575 days). The overall complication rate was 13.9 percent. No patients developed breast cellulitis, hyperemia, periprosthetic infection, or seroma. There was one implant exposure following expansion. Autoderm provides the advantages of lower pole support and breast shaping, without the disadvantages of increased infection, seroma, and the high cost associated with allograft and xenograft meshes. PMID:23629080

Selber, Jesse C; Clemens, Mark W; Oates, Scott; Baumann, Donald P



High hard magnetic properties and cellular structure of nanocomposite magnet Nd4.5Fe73.8B18.5Cr0.5Co1.5Nb1Cu0.2  

NASA Astrophysics Data System (ADS)

The formation of special nanostructure, cellular structure, in Nd4.5Fe73.8B18.5Cr0.5Co1.5Nb1Cu0.2 nanocomposite magnet has been observed by means of SEM for the first time. Ultrafine structure of cellules with thickness of 20 25 nm and length in range of 200 300 nm leads to high shape anisotropy of the materials. Therefore, high hard magnetic properties were obtained with (BH)max up to 17.3 MG Oe in ribbons with very high remanence of 13.5 kG. The role of Cr and Co in the formation and refinement of cellular structure is proposed. Effect of heat treatment on hard magnetic properties is discussed in detail.

The, N. D.; Chau, N.; Vuong, N. V.; Quyen, N. H.



Life-threatening soft-tissue infections of the neck.  


Four adult patients had life-threatening soft-tissue infections of the neck. One had Hemophilus influenzae infection, one had Streptococcus pyogenes infection, and two had polymicrobial mixed aerobic and anaerobic infections. Three of the four patients died despite appropriate antimicrobial therapy and surgical intervention. These cases demonstrate the spectrum of serious soft-tissue infections of the neck in both the compromised and the uncompromised host. Soft-tissue infections of the neck may be necrotizing or nonnecrotizing. Cellulitis secondary to H. influenzae and beta-hemolytic streptococci is usually non-necrotizing, whereas necrotizing infections are caused most commonly by synergistic organisms. Potential complications include septic shock, disseminated intravascular coagulation, acute renal failure, adult respiratory distress syndrome, mediastinitis, and pericarditis. Early recognition with aggressive medical and surgical therapy is essential to reduce the mortality. PMID:6366410

Beck, H J; Salassa, J R; McCaffrey, T V; Hermans, P E



Antibiotic overuse and resistance in dermatology.  


Antibiotics have a significant role in dermatology, treating a wide range of diseases, including acne, rosacea, inflammatory skin conditions and skin structure infections, such as cellulitis, folliculitis, carbuncles, and furuncles. Because of their consistent use, utility, and availability, antibiotics are susceptible to overuse within the medical practice, and, specific to this discussion, in the dermatologic setting. The issue of continuously increasing risk of antibiotic resistance remains an important concern to the dermatologist. The scope of this review will be to provide an overview of the common antibiotics used in the dermatologic setting with an emphasis on identifying areas of overuse, reported bacterial resistance, and discussion of clinical management aimed at decreasing antibiotic resistance. PMID:22591499

Chon, Susan Y; Doan, Hung Q; Mays, Rana Majd; Singh, Selina M; Gordon, Rachel A; Tyring, Stephen K


Australian Diabetes Foot Network: management of diabetes-related foot ulceration - a clinical update.  


Appropriate assessment and management of diabetes-related foot ulcers (DRFUs) is essential to reduce amputation risk. Management requires debridement, wound dressing, pressure off-loading, good glycaemic control and potentially antibiotic therapy and vascular intervention. As a minimum, all DRFUs should be managed by a doctor and a podiatrist and/or wound care nurse. Health professionals unable to provide appropriate care for people with DRFUs should promptly refer individuals to professionals with the requisite knowledge and skills. Indicators for immediate referral to an emergency department or multidisciplinary foot care team (MFCT) include gangrene, limb-threatening ischaemia, deep ulcers (bone, joint or tendon in the wound base), ascending cellulitis, systemic symptoms of infection and abscesses. Referral to an MFCT should occur if there is lack of wound progress after 4 weeks of appropriate treatment. PMID:22900873

Bergin, Shan M; Gurr, Joel M; Allard, Bernard P; Holland, Emma L; Horsley, Mark W; Kamp, Maarten C; Lazzarini, Peter A; Nube, Vanessa L; Sinha, Ashim K; Warnock, Jason T; Alford, Jan B; Wraight, Paul R



Treatment of hospitalized patients with complicated skin and skin structure infections: double-blind, randomized, multicenter study of piperacillin-tazobactam versus ticarcillin-clavulanate. The Piperacillin/Tazobactam Skin and Skin Structure Study Group.  

PubMed Central

We compared the efficacy and safety of two beta-lactam-beta-lactamase inhibitor combinations, namely, piperacillin-tazobactam and ticarcillin-clavulanate, in the treatment of complicated bacterial infections of skin that required hospitalization. The study was a randomized, double-blind, comparative trial involving 20 centers. The infections were classified as (i) cellulitis with drainage, (ii) cutaneous abscess, (iii) diabetic or ischemic foot infection, and (iv) infected wounds and ulcers with drainage. The clinical response rates were comparable for the two treatment regimens (61% of the patients were cured with piperacillin-tazobactam and ticarcillin-clavulanate and improvement was seen in 15 and 16% of patients treated with piperacillin-tazobactam and ticarcillin-clavulanate, respectively). Both regimens were found to be safe and well tolerated. These data support the use of piperacillin-tazobactam for initial empiric therapy of hospitalized patients with complicated skin and skin structure infections.

Tan, J S; Wishnow, R M; Talan, D A; Duncanson, F P; Norden, C W



A 13C-NMR study of exopolysaccharide synthesis in Rhizobium meliloti Su47 strain  

NASA Astrophysics Data System (ADS)

Metabolic pathways implied in the synthesis of succinoglycan produced by the Su47 strain of R. meliloti were evaluated by 13C-NMR spectroscopy after incubation with [1{-}13C] or [2{-}13C] glucose. The biosynthesis of this polymer by R. meliloti from glucose occurred by a direct polymerisation of the introduced glucose and by the pentose phosphate pathway. Les voies métaboliques impliquées dans la synthèse du succinoglycane produit par la souche Su47 de R. meliloti ont été évaluées par la spectroscopie de RMN du carbone 13 après incubation des cellules avec du [1{-}13C] ou [2{-}13C] glucose. La biosynthèse de ce polymère à partir du glucose se produit par polymérisation directe du glucose et par la voie des pentoses phosphate.

Tavernier, P.; Portais, J.-C.; Besson, I.; Courtois, J.; Courtois, B.; Barbotin, J.-N.



Gamma-delta T-cell lymphoma with CNS involvement presenting with proptosis: a case study workup, treatment and prognosis.  


Introduction: Ocular adnexal lymphomas are rare and T cell variants are a minor subset of these lymphomas. We aim to describe a case report which underlines the diagnostic and treatment challenge of this rare pathology. Case: A 34-year-old gentleman has been shown to have exophthalmos and dysfunction of cranial nerve V andVII unilaterally. Imaging including CT and MRI brain and orbits do not show a CNS component to the disease. It was later identified as an ocular adnexal lymphoma with a central nervous system (CNS) component diagnosed via lumbar puncture. Discussion: We highlight the importance of excluding ocular adnexal lymphoma and difficulty of management of the disease where it presents as a masquerade syndrome for orbital cellulitis. PMID:23030408

Sugnanam, Kirthi; Ooi, Lily; Mollee, Peter; Vu, Phung



The increased prevalence of severe necrotizing infections caused by non-group A streptococci.  


The authors report on 20 patients who were admitted to the University of Texas Health Science Center at San Antonio during a recent 4-month period with foot infections caused predominantly by non-group A streptococci. This number of patients was significantly greater than the number admitted to the same institution with the same diagnosis during the preceding 3 years. All patients had type 2 diabetes mellitus. In each case, a rapidly spreading cellulitis followed trauma to the foot, which necessitated emergent incision and drainage. Five patients required extensive fascial and skin debridement because of soft-tissue destruction, and two patients needed below-the-knee amputation because of uncontrolled infection. These cases suggest that non-group A streptococci, like group A streptococci, can cause serious skin and soft-tissue infections in patients with diabetes that may require aggressive surgical debridement despite appropriate antibiotic therapy. PMID:10507213

Reyzelman, A M; Lipsky, B A; Hadi, S A; Harkless, L B; Armstrong, D G



Pig bite injuries and infection: report of seven human cases.  

PubMed Central

Six patients developed local infection after being bitten or gored by swine. Wounding was often deep and occurred characteristically on the posterior aspect of the thigh. Severity of infection varied from simple wound infection with discharge and slough to cellulitis and abscess formation; pathogens included haemolytic streptococci, pasteurellae, Bacteroides sp., Proteus sp. and Escherichia coli and were usually isolated in mixed culture. A patient with Pasteurella aerogenes infection appears to be the first reported in England. A seventh patient developed Streptococcus milleri septicaemia after wounding himself while cutting teeth from piglets. It is suggested that a course of broad-spectrum antibiotics should be given as part of the initial treatment when patients present with the more severe pig bite injuries.

Barnham, M.



Advanced Upper Eyelid Sebaceous Gland Carcinoma with Deep Orbital Extension  

PubMed Central

Sebaceous gland carcinomas (SGC) are highly malignant lid tumors which originate from meibomian glands and rarely from the gland of Zeis, sebaceous gland of caruncle, eyebrows and periocular skin. In many cases correct diagnosis of SGC is delayed because of its ability to masquerade as a variety of other ocular conditions. A forty year old male presented with a left upper eyelid swelling with an ulcerated wound on its nasal aspect. A differential diagnosis of sebaceous gland carcinoma or preseptal cellulitis was made. Contrast enhanced computed tomography showed an ill defined soft tissue density mass in the left orbit encasing the whole of the optic nerve. A total exentration was performed. A diagnosis of meibomian gland carcinoma was confirmed on histopathology. This is a report of an advanced sebaceous gland carcinoma with deep orbital extension. An early diagnosis and appropriate treatment may decrease the long term morbidity and extend the survival rate of such patients.

Rizvi, Syed Ali Raza; Maheshwari, Veena



Use of the comet assay to measure DNA damage in cells exposed to photosensitizers and gamma radiation  

NASA Astrophysics Data System (ADS)

We used the comet assay associated with DNA-glycosylases to estimate DNA damage in cells exposed to gamma irradiation or photosensitized either with methylene blue or orange acridine. A calibration performed using irradiation allowed the measurement of the steady-state level and the yield of 8-oxodGuo as well as strand breaks and alkali-labile sites. Nous avons utilisé la méthode des comètes associée à des ADN-glycosylases, pour estimer les dommages de l'ADN dans des cellules après l'exposition à un rayonnement gamma ou après photosensibilisation par le bleu de méthylène ou l'acridine orange. Une calibration de la méthode des comètes a permis de mesurer le niveau basal et les taux de formation de 8-oxodGuo ainsi que le nombre de cassures de brins et de sites alcali labiles.

Pouget, J.-P.; Ravanat, J.-L.; Douki, T.; Richard, M.-J.; Cadet, J.



Une tumeur exceptionnelle du doigt: la tumeur fibreuse solitaire  

PubMed Central

La tumeur Fibreuse solitaire (TFS) est une prolifération fusocellulaire rare, souvent de localisation intra-thoracique. Nous rapportons le cas d'une localisation exceptionnelle au niveau du 3ème doigt de la main droite. En l'absence de marqueur spécifique l'interprétation de l'immuno-marquage dépend du contexte histo-morphologique. La similitude avec les différents néoplasmes à cellules fusiformes des tissus mous rend le diagnostic de ces tumeurs mésenchymateuses difficile et tardif. Dans 20à 30% des cas le comportement de la TFS est celui d'une tumeur maligne localement agressive et récidivante, avec des métastases rares et tardives. Ce comportement impose une surveillance prolongée après exérèse chirurgicale.

Harmouch, Taoufiq; Hamas, Nawal; Daoudi, Abdelkrim; Amarti, Afaf



Diagnosis and management of necrotising fasciitis: a multiparametric approach.  


Necrotising fasciitis (NF) is situated with myositis and myonecrosis at the severe end of a spectrum of skin and soft tissue infections but is far removed from erisepelas, impetigo and cellulitis. Inexperienced clinicians are easily misled by the protean manifestations of infection, especially exotoxin or superantigen mediated consequences from streptococcal NF. Early clinical suspicion and surgery are key to improving survival, and patients with NF need integrated multidisciplinary management, adjusted to the infecting organism(s), the site of infection, and the effects from any toxins produced. A multiparametric approach, incorporating various clinical and laboratory parameters, can aid aggressive management. This review describes the diagnosis and management of the major types of NF, emphasising important aetiological clues from the history and the appropriate usage of diagnostic investigations. The potential benefits of controversial therapeutic approaches, including hyperbaric oxygen and intravenous immunoglobulin, are discussed. PMID:20542593

Morgan, M S



Bilateral dacryoadenitis  

PubMed Central

Acute dacryoadenitis is an uncommon condition that involves inflammation of the lacrimal gland. In rare instances, dacryoadenitis may be bilateral. A delay in proper treatment of an otherwise simple case of dacryoadenitis may lead to significant soft tissue morbidity such as cellulitis, lacrimal gland abscess, or orbital abscess. We report the case of a 24-year-old male who presented to the emergency department with acute bilateral dacryoadenitis. The patient's symptoms did not respond to oral antibiotics and he subsequently required admission for intravenous antibiotics. During his hospitalization the patient had diagnostic testing to try to determine the etiology for his symptoms. The unique aspects of managing a case of bilateral dacryoadenitis as well as treatment recommendations are discussed in this case report.

Derr, Charlotte; Shah, Ankit



Antimicrobial Prophylaxis in Adults  

PubMed Central

Antimicrobial prophylaxis is commonly used by clinicians for the prevention of numerous infectious diseases, including herpes simplex infection, rheumatic fever, recurrent cellulitis, meningococcal disease, recurrent uncomplicated urinary tract infections in women, spontaneous bacterial peritonitis in patients with cirrhosis, influenza, infective endocarditis, pertussis, and acute necrotizing pancreatitis, as well as infections associated with open fractures, recent prosthetic joint placement, and bite wounds. Perioperative antimicrobial prophylaxis is recommended for various surgical procedures to prevent surgical site infections. Optimal antimicrobial agents for prophylaxis should be bactericidal, nontoxic, inexpensive, and active against the typical pathogens that can cause surgical site infection postoperatively. To maximize its effectiveness, intravenous perioperative prophylaxis should be administered within 30 to 60 minutes before the surgical incision. Antimicrobial prophylaxis should be of short duration to decrease toxicity and antimicrobial resistance and to reduce cost.

Enzler, Mark J.; Berbari, Elie; Osmon, Douglas R.



Clinical spectrum and predictive risk factors of major infections in hospitalized children with nephrotic syndrome.  


This observational study was conducted with the primary objective of studying the incidence of major infections in nephrotic syndrome (NS), while the secondary objectives were to evaluate the risk factors for and the etiological spectrum of major infections. Eighty six children up to 13 years of age fulfilling the International Study of Kidney Disease in Children (ISKDC) criteria for NS, who required 101 hospital admissions were recruited from November 2010 to July 2012. Major infections were defined as those that are disseminated, affecting deep organs, requiring hospitalization or potentially life-threatening. The incidence of major infections was 36.6%. Among the major infections, peritonitis and pneumonia together accounted for 72.9%, while urinary tract infections and cellulitis accounted for 16.2%. On logistic regression, severe ascites and more severe clinical types of NS independently predicted major infections, while serum cholesterol >400 mg/dL was the sole predictor of peritonitis. PMID:23502669

Ajayan, Payyadakkath; Krishnamurthy, Sriram; Biswal, Niranjan; Mandal, Jharna



Reactive angioendotheliomatosis in association with a well-differentiated angiosarcoma.  


A 55-year-old white female with a complex medical history including mixed connective tissue disease and peripheral vascular disease developed a group of red-purple papules on her proximal medial thigh that was followed, five months later, by the development of a large violaceous patch. She reported a history of radiation to this site (for melanoma) during her childhood. She was admitted to the hospital with a presumptive diagnosis of cellulitis, but failed to respond to antibiotics. A biopsy was performed and demonstrated a well-differentiated angiosarcoma arising in conjunction with reactive angioendotheliomatosis. Excision of the lesion was performed, and fifteen months of follow-up have shown no recurrence or metastasis. PMID:16148413

Clarke, Loren E; Julian, Kathleen G; Clarke, Jennie T; Ioffreda, Michael D



Chronic osteomyelitis of the clavicle.  


Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite rare. It is often mistaken for a fracture or a possible neoplasm on plain x-rays. Tomograms and CT scanning are confirmatory, and in early cases, technetium-99m bone scanning can be helpful. Treatment must include early, aggressive surgical debridement of all affected tissues, followed by wound coverage with a well-vascularized flap and perioperative antibiotics. PMID:2734407

Granick, M S; Ramasastry, S S; Goodman, M A; Hardesty, R



Actinobacillus lignieresii infection in two horses.  


A 10-year-old pregnant Norwegian Fjord horse was examined for gross swelling of the muzzle of 2 years' duration. Examination of biopsy specimens revealed diffuse dermal fibrosis, micropustule formation, and vascular thrombosis; large numbers of Actinobacillus lignieresii were isolated in pure culture. Prolonged treatment with i.v. administration of sodium iodide and oral administration of trimethoprim-sulfamethoxazole caused regression of the swelling and did not induce abortion. A 5-month-old American Paint filly was examined for swelling in the udder region. Bacteriologic culture of purulent material obtained from the left teat revealed A lignieresii. Treatment with oral administration of rifampin and trimethoprim-sulfamethoxazole resulted in complete resolution of clinical signs. To the authors' knowledge, these findings represent the first report of mastitis and chronic nasal cellulitis caused by A lignieresii infection in horses. PMID:10496138

Carmalt, J L; Baptiste, K E; Chirino-Trejo, J M



Immunopathogenesis of streptococcal deep tissue infections.  


Streptococcus pyogenes is an important human pathogen that can cause a variety of diseases in immunocompetent individuals ranging from uncomplicated superficial infections to severe life-threatening infections including rapidly progressing deep tissue infections, such as necrotizing fasciitis (NF) and severe cellulitis. The pathogenesis of these infections is complex and multifactorial involving numerous virulence factors expressed by the bacteria. Here, we review data from epidemiologic, pathogenomic, and pathogenesis studies that have provided insight into the host-pathogen interactions that contribute to S. pyogenes tissue infections. The role of tissue-specific streptococcal types, intracellular bacterial persistence, and other immune evasion strategies resulting in massive bacterial load at the tissue site, as well as virulence factors contributing to a local hyperinflammatory response are highlighted. A particular focus is on in vivo findings in patients that provide insight into host and bacterial factors that are expressed at the infected tissue site, and the mechanisms underlying tissue pathology. PMID:23224738

Johansson, Linda; Norrby-Teglund, Anna



Unilateral RS3PE in a Patient of Seronegative Rheumatoid Arthritis  

PubMed Central

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare but well-reported clinical entity. It is classically described as symmetrical involvement of both upper extremities. Asymmetrical involvement had also been reported, but unilateral presentation is very rare. We hereby report a case of unilateral RS3PE in a patient of seronegative rheumatoid arthritis which was initially misdiagnosed as cellulitis and was given high dose antibiotics without any significant improvement. Later a rheumatologic consultation leads to a prompt diagnosis, and treatment with steroids leads to dramatic reversal of symptoms. This case demonstrates the rare presentation of this rare clinical entity and highlights the necessity of awareness regarding unilateral disease to clinicians.

Varshney, Ankur Nandan; Kumar, Nilesh; Tiwari, Ashutosh; Anand, Ravi; Prasad, Sashi Ranjan; Anand, Arvind; Mishra, Abhinandan; Singh, N. K.





The most commonly recognized form of lipodermatosclerosis (LDS), chronic LDS presents with induration and hyperpigmentation of the skin involving the one or both of the lower legs in a characteristic "inverted champagne bottle" appearance. Associated with venous insufficiency, LDS is most common in middle aged women. In addition to chronic LDS, an acute form may also occur and is often misdiagnosed as cellulitis, inflammatory morphea, or erythema nodosum. The "acute" refers to the symptoms present that are exquisite pain. Treatment of LDS is based on the clinical presentation with compression therapy as the mainstay of treatment if tolerated. For acute LDS, patients often cannot tolerate compression therapy due to pain. We advise the use of fibrinolytic therapy, if available, until the patient can tolerate compression stockings. PMID:20666825

Miteva, Maria; Romanelli, Paolo; Kirsner, Robert S


Chronic osteomyelitis of the clavicle  

SciTech Connect

Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite rare. It is often mistaken for a fracture or a possible neoplasm on plain x-rays. Tomograms and CT scanning are confirmatory, and in early cases, technetium-99m bone scanning can be helpful. Treatment must include early, aggressive surgical debridement of all affected tissues, followed by wound coverage with a well-vascularized flap and perioperative antibiotics.

Granick, M.S.; Ramasastry, S.S.; Goodman, M.A.; Hardesty, R.



Pott puffy tumor: a rare complication of sinusitis.  


Pott puffy tumor, a rare complication of sinusitis in adults, appears as a localized swelling over the frontal region or forehead. This swelling is due to a subperiosteal abscess resulting from osteomyelitis of the underlying frontal bone. This condition may be associated with an epidural purulent collection, subdural empyema, and intracerebral abscess. This entity is rare--even forgotten--since the advent of modern powerful antibiotics. A 27-year-old male was referred to ENT OPD with forehead swelling, fever and headache. The patient had mooth doughy swelling of the foreheadwith surrounding cellulitis and swelling spreading to the orbits as periorbital odema. On examination, patient had very poor oral hygiene with severe dental caries. CT with contrast conformed pansinusitis with erosion of frontal bone and abscess. An early recognition of this forgotten complication of sinusitis will help avoid severe neurological sequelae and increased morbidity and mortality. PMID:22634502

ur Rehman, Ayub; Muhammad, Muhammad Noor; Moallam, Fadi Adnan


Complex Regional Pain Syndrome (CRPS type-1) in an Adolescent Following Extravasation of Dextrose Containing Fluid-an Underdiagnosed Case.  


Due to its complex pathophysiology and wide spectrum of clinical manifestations, the diagnosis of CRPS is often missed in the early stage by primary care physicians. After being treated by a primary care physician for 5 months for chronic cellulitis, a 16-year-old girl was referred to our hospital with features of type-1 CRPS of the right upper extremity. Inability to diagnose early caused prolonged suffering to the girl with all the consequence of CRPS. The patient responded well with marked functional recovery from multimodal therapy. Ability to distinguish CRPS from other pain conditions, referral for specialty care at the appropriate time and full awareness of this condition and its clinical features among various healthcare professionals are essential in reducing patient suffering and stopping its progression towards difficult-to-treat situations. PMID:21716610

Subedi, Asish; Bhattarai, Balkrishna; Biswas, Binay K; Khatiwada, Sindhu



Complex Regional Pain Syndrome (CRPS type-1) in an Adolescent Following Extravasation of Dextrose Containing Fluid-an Underdiagnosed Case  

PubMed Central

Due to its complex pathophysiology and wide spectrum of clinical manifestations, the diagnosis of CRPS is often missed in the early stage by primary care physicians. After being treated by a primary care physician for 5 months for chronic cellulitis, a 16-year-old girl was referred to our hospital with features of type-1 CRPS of the right upper extremity. Inability to diagnose early caused prolonged suffering to the girl with all the consequence of CRPS. The patient responded well with marked functional recovery from multimodal therapy. Ability to distinguish CRPS from other pain conditions, referral for specialty care at the appropriate time and full awareness of this condition and its clinical features among various healthcare professionals are essential in reducing patient suffering and stopping its progression towards difficult-to-treat situations.

Bhattarai, Balkrishna; Biswas, Binay K; Khatiwada, Sindhu



An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma  

PubMed Central

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a very rare form of skin lymphoma that is localized primarily to the subcutaneous adipose tissue without palpable involvement of the lymph nodes. Diagnosis of SPTCL is a challenge, especially during its early phases when symptoms mimic other, more common conditions, such as benign panniculitis, eczema, dermatitis, psoriasis and cellulitis. Clinical and systemic features are nonspecific and can include fever, chills, and weight loss. Further complicating diagnosis is the high number of false negatives provided by biopsy. Here we present a case of SPTCL that illustrates the full course of the disease, from presentation and multiple misdiagnoses to correct disease recognition and successful treatment. A review of the challenges of diagnosis is provided with recommendations for more accurate and timely recognition of SPTCL.

Bagheri, Farshad; Cervellione, Kelly L.; Delgado, Belkis; Abrante, Luis; Cervantes, Jose; Patel, Jitendra; Roth, Alan



Death due to an unrecognized groin abscess in a drug addict: a retrospective study.  


Intravenous drug injection persists despite health risks and medical complications. Venous thrombosis, septic thrombophlebitis, artery necrosis, arterio-venous fistula, mycotic aneurysm, dissecting hematoma, pseudoaneurysm formation, and soft tissues infections (i.e. abscesses, cellulitis, infected ulcers), are some of the major clinical consequences lives threatening. The aim of this work is to present this unusual autoptic case of a drug addict man died for an unrecognized groin abscess referred to the Institute of Legal Medicine, University of Chieti, causing femoral vein's erosion, and to analyse the most common patterns of vascular lesions among drug addicts. It could be stimulated a new scientific debate because groin injections and their vascular complications increase over years; while soft tissue infections may hide vascular lesions' diagnosis. So physicians should have a high index of suspicion for serious vascular problems, among intravenous drug users (IDUs): prevention for avoiding groin injection and a proper treatment are necessary. PMID:23756501

D'Ovidio, Cristian; Vellante, Paola; Costantini, Sara; Carnevale, Aldo



Serratia marcescens-contaminated baby shampoo causing an outbreak among newborns at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.  


During November 2008 to January 2009, 11 babies in the neonatal intensive care (NICU) and three babies in the nursery were infected with Serratia marcescens at King Abdulaziz University Hospital in Saudi Arabia. Overall, fifteen infections were identified among 11 newborns in the NICU: septicaemia (five cases), purulent conjunctivitis (three), urinary tract infection (two), meningitis (two) and cellulitis (one). Three newborns in the nursery had three infections: purulent conjunctivitis (two cases) and omphalitis (one). Thirteen of 14 babies recovered fully but one died from S. marcescens meningitis and septicaemia. All infections were traced to intrinsically contaminated baby shampoo introduced to the units five days before the first reported case. The outbreak terminated following withdrawal of the shampoo product. PMID:21392846

Madani, T A; Alsaedi, S; James, L; Eldeek, B S; Jiman-Fatani, A A; Alawi, M M; Marwan, D; Cudal, M; Macapagal, M; Bahlas, R; Farouq, M



Ludwig's Angina - An emergency: A case report with literature review  

PubMed Central

Ludwig's angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. Early diagnosis and immediate treatment planning could be a life-saving procedure. Here we report a case of wide spread odontogenic infection extending to the neck with elevation of the floor of the mouth obstructing the airway which resulted in breathlessness and stridor for which the patient was directed to maintain his airway by elective tracheostomy and subsequent drainage of the potentially involved spaces. Late stages of the disease should be addressed immediately and given special importance towards the maintenance of airway followed by surgical decompression under antibiotic coverage. The appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection remains the standard protocol of treatment in advanced cases of Ludwig's angina.

Candamourty, Ramesh; Venkatachalam, Suresh; Babu, M. R. Ramesh; Kumar, G. Suresh



Clinical trial of cefonicid for treatment of skin infections.  


Twenty patients with skin and soft-tissue infections were treated with parenteral cefonicid. Cultures obtained in cellulitis cases from an aspirate of a leading edge of inflammation were positive in 42% of these patients. Pathogens isolated were Staphylococcus aureus (six strains), Proteus mirabilis (one strain), and Streptococcus agalactiae. Adverse effects were pain on intramuscular injection (two patients), rash (one patient), and positive Coombs test (one patient). All side effects were mild and none required discontinuing antibiotic therapy. A single treatment failure occurred in a patient with an undrained perirectal abscess. Cefonicid may be a useful drug in the treatment of skin and soft-tissue infections. The long half-life of cefonicid (4.8 h) is a valuable advantage and may facilitate patient compliance and convenience. PMID:6351735

Gremillion, D H; Winn, R E; Vandenbout, E



Clinical trial of cefonicid for treatment of skin infections.  

PubMed Central

Twenty patients with skin and soft-tissue infections were treated with parenteral cefonicid. Cultures obtained in cellulitis cases from an aspirate of a leading edge of inflammation were positive in 42% of these patients. Pathogens isolated were Staphylococcus aureus (six strains), Proteus mirabilis (one strain), and Streptococcus agalactiae. Adverse effects were pain on intramuscular injection (two patients), rash (one patient), and positive Coombs test (one patient). All side effects were mild and none required discontinuing antibiotic therapy. A single treatment failure occurred in a patient with an undrained perirectal abscess. Cefonicid may be a useful drug in the treatment of skin and soft-tissue infections. The long half-life of cefonicid (4.8 h) is a valuable advantage and may facilitate patient compliance and convenience.

Gremillion, D H; Winn, R E; Vandenbout, E



Periocular necrotizing fasciitis causing blindness.  


IMPORTANCE Periocular necrotizing fasciitis is a rare but potentially devastating disease, accompanied by high rates of morbidity and mortality. OBSERVATIONS We report 5 cases of periocular necrotizing fasciitis resulting in severe vision loss, 3 of which required exenteration to contain the disease and only 1 of which recovered vision. Three cases were caused by group A streptococcus; 1, by methicillin-resistant Staphylococcus aureus; and 1, by Streptococcus anginosus constellatus. CONCLUSIONS AND RELEVANCE Providers should maintain a high clinical suspicion for necrotizing fasciitis and distinguish it from more common forms of cellulitis. As seen in these 5 cases, periocular necrotizing fasciitis may cause severe visual loss more often than previously recognized. To our knowledge, this is also the first report of Streptococcus anginosus constellatus causing necrotizing fasciitis. PMID:23868053

Shield, David R; Servat, Javier; Paul, Sean; Turbin, Roger E; Moreau, Annie; de la Garza, Adam; El Rassi, Edward; Silbert, Jonathan; Lesser, Robert; Levin, Flora



Truth under a masquerade!  


A 32-year-old woman presented with bilateral periorbital oedema of 2 days duration which progressed to proptosis, chemosis with diminution of vision rapidly within a week. She was a known case of adenocarcinoma of the rectum who was treated with surgery and chemotherapy 6 months earlier. Metastasis workup carried out then was negative. On examination, she had bilateral axial proptosis with sluggish pupillary reactions with restricted extra ocular movements. Fundus examination was normal. Systemically, the patient was of poor build and was undernourished. Haemogram showed raised total counts and erythrocyte sedimentation rate. CT orbit and brain showed metastasis to the frontal bones and orbit. On investigating further, the patient had liver and lung metastasis. The patient was started on chemotherapy, but she succumbed to the disease within a week. This case is reported to highlight how bilateral orbital cellulitis can be a presenting sign of systemic metastasis in treated malignancies. PMID:23821637

Gonsalves, Sarita R J; Lobo, Geover Joslen; Mendonca, Norman



The technetium phosphate bone scan in the diagnosis of osteomyelitis in childhood  

SciTech Connect

We reviewed the technetium phosphate scans of 280 patients who had been referred with a clinical diagnosis of osteomyelitis in order to establish the diagnostic accuracy of this procedure. Strict criteria were established to define two subgroups: one of patients with proved osteomyelitis and one of patients who definitely did not have osteomyelitis. The scan correctly identified osteomyelitis at fifty-five of sixty-two sites, and was correctly negative in seventy-four of seventy-nine patients without osteomyelitis. The scan correctly distinguished all cases of cellulitis or soft-tissue abscess from osteomyelitis, but identified osteomyelitis in eight of thirty-nine patients with septic arthritis. The phosphate bone scan maintained this accuracy through any duration of symptoms, and performed almost equally well at all skeletal sites and in all age groups.

Howie, D.W.; Savage, J.P.; Wilson, T.G.; Paterson, D.



Experimental infections of the musculoskeletal system: evaluation with MR imaging and Tc-99m MDP and Ga-67 scintigraphy  

SciTech Connect

Acute osteomyelitis, soft-tissue infection, or both were experimentally produced in 38 New Zealand white rabbits, and three-phase technetium-99m methylene diphosphonate, gallium-67, and magnetic resonance (MR) images were obtained 7 or 14 days after infection. There was no significant difference between radionuclide studies and MR images in the detection of osteomyelitis, but MR imaging was significantly more sensitive (100% vs. 69%; P less than .01) in the detection of soft-tissue infection. In addition, cellulitis could not be distinguished from soft-tissue abscess on radionuclide studies, whereas MR imaging was 92% accurate in depicting soft-tissue abscesses. Further research is necessary to determine how to relate these findings to true human clinical situations.

Beltran, J.; McGhee, R.B.; Shaffer, P.B.; Olsen, J.O.; Bennett, W.F.; Foster, T.R.; McCalla, M.S.; Iskra, L.A.; Blagg, R.L.; Biller, D.S.



Computerized tomography of pelvic osteomyelitis in patients with spinal cord injuries  

SciTech Connect

Computerized tomography (CT) was performed in 19 patients with spinal cord injury (SCI) who had large pressure sores and in whom other complications were suspected. CT detected the depth, extent, and degree of undermining of the edges of the pressure sores in 19 of 27 lesions. Conventional radiography detected four cases of pelvic osteomyelitis. CT detected eight additional cases of pelvic osteomyelitis, as well as eight clinically unsuspected peripelvic and intrapelvic abscesses. Technetium-99m bone scanning was not very helpful because of localization in chronic proliferative changes of bone and widespread foci of myositis ossificans, as well as in osteomyelitis. Gallium-67 scanning detected only one of six abscesses. It was not very helpful because of confusion of abscess and osteomyelitis with intense soft tissue swelling and cellulitis, which are often associated with pressure sores in patients with chronic SCI. CT was found to be, by far, the modality of choice for detection of pelvic osteomyelitis and abscess in patients with SCI.

Firooznia, H.; Rafii, M.; Golimbu, C.; Sokolow, J.



Opportunistic metastatic porocarcinoma after saphenous venectomy for coronary bypass surgery.  


Immunocompromised areas of the skin, caused by chronic lymphoedema, paraplegia, infections or traumas, represent a site of regional neuroimmunocutaneous destabilization, termed the immunocompromised cutaneous district (ICD), in which malignancies and other opportunistic disorders are more likely to occur. We report the case of a metastatic porocarcinoma (PC) occurring on a lymphoedematous limb in a 72-year-old man. We reviewed the literature to better understand the potential pathogenetic mechanisms behind this condition. It has been reported that removal of the leg vein destroys the medial group of the superficial lymphatic vessels and alters the normal lymph drainage of the leg, predisposing to recurrent cellulitis. Our observations suggest that saphenous venectomy can induce development of an ICD. We suggest that PC, a rare cutaneous tumour, should be included in the growing list of tumours arising in the ICD. PMID:23777492

Baroni, A; Russo, T; Piccolo, V; Siano, M; Russo, D; Nacca, L; Ruocco, E



Soft tissue infections with atypical mycobacteria in two patients with inflammatory rheumatic diseases using TNF-inhibitors and/or leflunomide.  


Infections of the soft tissues due to atypical mycobacteria are relatively uncommon. We describe two cases. A 61-year-old woman with rheumatoid arthritis (RA) who was treated with the combination of the TNF inhibitor etanercept (Enbrel) and leflunomide (Arava), developed paronychia and cellulitis of the index finger due to Mycobacterium chelonae/abscessus complex. The patient was successfully treated with clarithromycin and surgical debridement. A second case describes a 50-year-old man with ankylosing spondylitis, receiving infliximab (Remicade) and low dose corticosteroids, who developed a granulomatous infection of the right thumb and forearm due to Mycobacterium marinum.The patient was successfully treated with clarithromycin and ethambutol. The increased risk for subcutaneous mycobacterial infections in these cases are probably related to the DMARD treatment with a TNF-inhibitor and leflunomide. PMID:21630616

Steyaert, S; Stappaerts, G; Mareen, P; Dierick, J


Bullae and Sweat Gland Necrosis in the Differential Diagnosis for Vibrio vulnificus Infection in an Alcoholic Patient  

PubMed Central

Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.

Kim, Gun-Wook; Park, Hyun-Je; Kim, Hoon-Soo; Kim, Su-Han; Ko, Hyun-Chang; Kim, Moon-Bum



Clinical and Bacteriological Evaluation of Cefoxitin Therapy in Children  

PubMed Central

Cefoxitin, a parenteral cephamycin ?-lactam antibiotic, was evaluated for safety and efficacy in children with bacterial infections other than meningitis. Twentysix patients between 3 months and 7 years of age were treated with 80 to 160 mg/kg per day. The most common diagnoses were cellulitis (13 patients), pneumonia (5 patients), and bone and joint infection (4 patients). Nine patients were bacteremic. The most frequently recovered pathogens were Staphylococcus aureus (six patients), Haemophilus influenzae (four patients), and Streptococcus pneumoniae (three patients). All organisms were susceptible to cefoxitin. All 26 children were considered improved or cured. No severe adverse reactions were encountered. Phlebitis (4%), eosinophilia (12%), and elevated liver function tests (4%) were associated with therapy. Cefoxitin appears to be a safe, effective, and well-tolerated antibiotic when used in children with susceptible bacterial infections other than meningitis.

Jacobson, Jay A.; Santos, Jose I.; Palmer, W. Martin



Perirectal inflammatory disease: CT findings.  


The findings on computed tomographic (CT) scans were reviewed in 42 patients with perirectal inflammatory disease and suspected perirectal abscesses. CT was reliable for use in distinguishing perirectal abscesses from cellulitis and in localizing both supralevator and infralevator abscesses. CT allowed correct diagnosis of 13 surgically proved perirectal abscesses in ten patients, including three with residual abscesses after surgical drainage. In three patients with supralevator abscesses, the abscess was missed on initial surgical exploration. In patients without abscesses, CT was helpful in evaluating the extent of perirectal inflammation; however, it was not possible to determine its cause. The anatomy on CT scans of the pararectal spaces is reviewed, with emphasis on useful anatomic landmarks in the axial plane for distinguishing supralevator from infralevator abscesses. PMID:3763858

Guillaumin, E; Jeffrey, R B; Shea, W J; Asling, C W; Goldberg, H I



MRI evaluation of diabetic muscle infarction.  


Diabetic muscle infarction (DMI) is a painful and potentially serious complication in patients with poorly controlled diabetes mellitus. The incidence of DMI is likely much greater than reports in the literature suggest, perhaps secondary to the difficulty in making the diagnosis and excluding other more serious etiologies. This paper describes the role of MRI in the evaluation of a diabetic patient with a painful, swollen limb. Early application of MRI can more accurately classify the disease process and focus the differential diagnosis, thus avoiding the hazards of medical therapy associated with other etiologies such as deep venous thrombosis, cellulitis, or osteomyelitis. This paper describes the evaluation and diagnostic pitfalls encountered in two patients. MRI techniques and applications are presented with a discussion of clinical and radiological differential diagnoses. PMID:7739375

Van Slyke, M A; Ostrov, B E



Dens evaginatus: the hornet's nest of adolescent orthodontics.  


Dens evaginatus is a rare dental anomaly that occurs during tooth development and results in an abnormal protrusion from the occlusal surface of the affected tooth, often in the area of the central groove between the buccal and lingual cusps. Of clinical importance to the orthodontist is that these occlusal tubercles fracture easily or can be worn away, resulting in direct pulp exposure in a noncarious tooth. This can cause severe complications, including loss of tooth vitality, facial infection in the form of an abscess or cellulitis, or osteomyelitis of the jaw. If extraction of premolars is indicated for orthodontic treatment after careful diagnosis and treatment planning, it is paramount to establish the health of the premolars that will remain in the dentition before extracting the teeth. PMID:23561419

Turner, John W; Kluemper, G Thomas; Chance, Kenneth; Long, Linwood Sonny



A rare diagnostic challenge in acute appendicitis: a case report.  


Although rare, acute appendicitis presenting as a remote abscess with cellulitis in the gluteal region, retroperitoneal region, groin, or thigh does occur and may present a diagnostic challenge. We report a case of a 78-year-old woman presenting with an extensive gas-forming abscess in the right gluteal region secondary to perforated appendicitis without significant gastrointestinal symptoms. Computed tomography (CT) demonstrated a retroperitoneal abscess extending along the sacropelvic surface of the ilium to the subcutaneous tissue. Subsequently, laparotomy revealed retrocecal appendicitis perforated at the base of the cecum, and contained in the retroperitoneum without any signs of peritonitis. This case not only represents an unusual manifestation of acute appendicitis, but also alerts us to the importance of anatomical considerations when interpreting disease extent with imaging. In the differential diagnosis of gluteal or upper thigh abscesses, the rare possibility of perforated acute appendicitis should be considered. PMID:22702216

Kawashima, Masumi; Hashimoto, Yasushi; Sudo, Takeshi; Uemura, Kenichiro; Nakashima, Akira; Sueda, Taijiro; Murakami, Yoshiaki



Pyoderma gangrenosum mimicking a diabetic foot infection: a case report.  


An adult with ulcerative colitis and diabetes presented with a painful, swollen, edematous left foot. Diagnostic images and laboratory tests were inconclusive. Antibiotics were started immediately but aggravated his symptoms, and the laboratory results worsened. His foot was debrided twice per protocol for treating diabetic foot ulcers or cellulitis. After debridement, his condition worsened rapidly. Pyoderma gangrenosum was correctly diagnosed on the basis of massive neutrophilic infiltration detected in the biopsy tissue and because the lesion was well-defined and colored deep red to violet, unlike the bullosis diabeticorum blisters observed in the diabetic foot. His foot improved with systemic corticosteroids and topical wound care, and a skin defect was treated with a skin graft. After 9 months, his foot was well healed. Pyoderma gangrenosum can be diagnosed by careful examination and must be distinguished from an ulcerated diabetic foot lesion. PMID:23073270

Lee, Ho Seong; Choi, Young Rak; Ha, Sung Hoon; Jeong, Jae Jung



Diesel fuel injury to the orbit.  


A 48-year-old man was seen in the Wills Eye Institute emergency room for pain and decreased vision after having a diesel engine fuel cylinder explosion in his face. Clinical examination showed proptosis, decreased extraocular motility, and increased intraocular pressure; CT scan imaging revealed hypodense areas within the orbit. His orbital signs rapidly worsened despite aggressive antibiotics, steroids, and surgical intervention. Two orbitotomies revealed diesel fuel infiltration of the intraconal and extraconal spaces that proved impossible to evacuate completely. The patient ended up losing vision from an intense chemical cellulitis with subsequent orbital compartment syndrome and optic neuropathy. This case highlights the severity of orbital chemical injuries and their variable prognoses despite aggressive management. PMID:23034684

Rabinowitz, Michael P; Goldstein, Scott M



Trichotillomania and dermatitis artefacta: a rare coexistence.  


A 24-year-old pregnant female patient presented with complains of bilateral lower limb swelling and fever for 1 month. On examination, blood pressure was 144/94?mmHg along with pitting pedal edema. She had bizarre skin lesions, aligned longitudinally and distributed over the approachable site of the body with tapering ends and in various stages of healing. Lower limbs examination also revealed similar lesions with signs of cellulitis. Her scalp had short and distorted hair suggesting pulling and plucking. These skin lesions and the denial of self-infliction by the patient made us reach the diagnosis of dermatitis artefacta with trichotillomania. Psychotherapy was advocated along with conservative management of skin lesions. The patient improved and is under our follow up. PMID:22934222

Varyani, Neeraj; Garg, Sunny; Gupta, Garima; Singh, Shivendra; Tripathi, Kamlakar



Trichotillomania and Dermatitis Artefacta: A Rare Coexistence  

PubMed Central

A 24-year-old pregnant female patient presented with complains of bilateral lower limb swelling and fever for 1 month. On examination, blood pressure was 144/94?mmHg along with pitting pedal edema. She had bizarre skin lesions, aligned longitudinally and distributed over the approachable site of the body with tapering ends and in various stages of healing. Lower limbs examination also revealed similar lesions with signs of cellulitis. Her scalp had short and distorted hair suggesting pulling and plucking. These skin lesions and the denial of self-infliction by the patient made us reach the diagnosis of dermatitis artefacta with trichotillomania. Psychotherapy was advocated along with conservative management of skin lesions. The patient improved and is under our follow up.

Varyani, Neeraj; Garg, Sunny; Gupta, Garima; Singh, Shivendra; Tripathi, Kamlakar



Managing blisters in competitive athletes.  


Friction blisters can have a negative effect on an individual's ability to perform his or her sport or duties. In a recent study, 69% of soldiers participating in a 20-km road march were found to have blisters, 10% of whom required medical intervention. Blistering of the feet is one of the most common injuries sustained by runners while training and racing. Although most blisters are minor and can be treated conservatively, others can lead to intense pain, cellulitis, and even sepsis. The best way to treat friction blisters is to prevent them; however, if they do occur, timely and effective treatment will help prevent the complications that can impede athletic performance. PMID:12831678

Brennan, Fred H



Is this really a capillary haemangioma?  


Periocular tumours in newborn babies are not uncommon and their diagnosis and management can be challenging. Capillary haemangioma is the most common of them and superficial ones are easy to recognise. Deep-seated (orbital) lesions can mimic various other orbital mass lesions - dermoid cysts, cellulitis, lymphangioma and the more serious rhabdomyosarcoma and neuroblastoma. A careful elicitation of history, physical examination, and appropriate orbital imaging (ultrasound for superficial ones and magnetic resonance imaging/angiography for deep-seated lesions) helps in the diagnosis. This is a brief report of a very large vascular lesion involving the lower lid with very atypical clinical features. The approach to diagnosis and successful treatment and the histological features are discussed. PMID:18097979

Reddy, Aravind R; Chang, B Y P; Bradbury, J A



Fibrosis in Hepatitis C Patients Predicts Complications After Elective Total Joint Arthroplasty.  


Effects of Hepatitis C on total hip (THA) and total knee arthroplasty (TKA) outcomes are poorly understood. Seventy-two hepatitis C patients underwent 77 primary THA or TKA and were retrospectively identified, stratified by fibrosis and thrombocytopenia and compared to matched controls. Overall, Hepatitis C and control patients had similar outcomes. After TKA, fibrotic hepatitis C patients demonstrated a greater average hemoglobin drop than non-fibrotic hepatitis C patients (4.9 versus 3.8, P=0.023), greater deep infection rate (21% versus 0%, P=0.047), and rate of cellulitis (21% versus 0%, P=0.047). Thrombocytopenia showed a trend toward greater infections. Prior to fibrosis, Hepatitis C patients appear to be at no increased risk of complication after joint arthroplasty. Evaluation of fibrosis may predict poor outcome in Hepatitis C patients. PMID:23648106

Orozco, Fabio; Post, Zachary D; Baxi, Omkar; Miller, Adam; Ong, Alvin



[Septic shock by Vibrio vulnificus at the coast Gulf of Mexico].  


Vibrio vulnificus is a Gram-negative bacterium which is found in marine environments and where there is a partly enclosed coastal body of water with one or more rivers or streams flowing into it, and with a free connection to the open sea. The infection by these bacteria can cause primary septicemia by two mechanisms: upon consuming crustaceans, mollusks and some fish (filtering shellfish) raw or barely cooked or by an open injury in contact with seawater. The patients with infections of the primary injury by Vibrio vulnificus developed contaminated painful cellulitis that progresses quickly as well as a marked local inflammation with signs of hemorrhaging. We described a case of Vibrio vulnificus sepsis, with emphasis on the clinical picture, the epidemiological background and lab findings; finally we did a brief review of the literature related to the case. PMID:21982195

Baizabal-Ramírez, Oscar; Negrete-Pérez, Mónica; Guerrero-Daza, Damayanty; Martínez-Herrera, Nahum; Aburto-Desachy, Yolanda; Mata-Miranda, Pilar


Angiosarcoma Presenting with Minor Erythema and Swelling  

PubMed Central

A 76-year-old man presented with slowly progressive swelling in his forehead and left upper eyelid over the course of three months. CT scanning showed non-specific enhancement of subcutaneous tissues, suggesting a low-grade cellulitis. Poor response to treatment prompted an MRI, which revealed the presence of a soft tissue lesion. Biopsy of this lesion was positive for angiosarcoma. The patient underwent chemotherapy and radiation, but unfortunately succumbed to his malignancy eight months later. This case illustrates a rare example of facial/periorbital angiosarcoma, a benign-appearing but aggressive tumor associated with a high incidence of mortality. A review of the literature and current treatment options are discussed.

Cox, Catherine A.; Wein, Richard O.; Ghafouri, Roya; Laver, Nora M.; Heher, Katrinka L.; Kapadia, Mitesh K.



Syndrome de lev?e d'obstacle : physiopathologie et prise en charge  

PubMed Central

Résumé Le syndrome de levée d’obstacle est une polyurie massive faisant suite au traitement d’une insuffisance rénale obstructive. Les mécanismes physiopathologiques sont multiples : un état de surcharge hydrique qui dépend du caractère complet ou incomplet de l’obstacle, des anomalies tubulaires (atteinte de la capacité de dilution et de concentration des urines, diminution de la réabsorption du sodium, fuites de potassium, troubles de l’acidification des urines, insensibilité des cellules tubulaires à l’hormone antidiurétique), ainsi que des facteurs biochimiques et immunologiques sont mis en jeu. La levée d’un obstacle nécessite une surveillance clinique et biologique stricte (diurèse horaire, état hémodynamique, état d’hydratation, créatininémie, urémie, ionogramme sanguin). Le traitement a pour but d’éviter les troubles hémodynamiques et métaboliques graves, et repose sur le principe de la compensation des pertes hydroélectrolytiques.

Ziouziou, Imad; Daoudi, Anass; Nouri, Anass; Karmouni, Tarik; El Khader, Khalid; Koutani, Abdellatif; Andaloussi, Ahmed Iben Attya



Transfert d'énergie linéique et radiosensibilité cellulaire  

NASA Astrophysics Data System (ADS)

The response of human tumour cell lines to in vitro irradiation by high LET particles depends on several factors. For charged particles, there is an increase in radio-sensitivity with LET up to LET values of about 200 KeV/m, then it decreases for higher values. In clinical practice, the increase in the average LET value with depth leads to a continuous increase in relative biological effectiveness (RBE). The probability of particle traversal through the nucleus producing lethal damage is almost 1 for particles with very high LET values such as 7 MeV Ar (LET = 1500 KeV/?m); it is only 0.02 for 400 MeV O ions (LET = 20 KeV/?m). RBE is inversely related with dose, this relation being more marked for cells with small ?/beta values after photon irradiation according to the linear-quadratic formula. Particles that are less efficient than photons in terms of average cell death induce heavy individual cell damage, as shown by the yield of multiple micronuclei (MN). With regard to RBE and intrinsic radiosensitivity, recent data using both the clonogenic method and the MN assay indicate that the higher the radioresistance to photon irradiation, the higher the RBE. La réponse des cellules tumorales humaines à l'irradiation in vitro par des particules de TEL élevé dépend de plusieurs facteurs. Pour les particules chargées, la radiosensibilité augmente avec le TEL jusqu'à des valeurs de TEL voisines de 200 KeV/?m, puis diminue pour des valeurs de TEL supérieures. En clinique, l'augmentation du TEL moyen de la particule chargée en profondeur est responsable d'une efficacité biologique relative (EBR) croissante. La probabilité de mortalité de la cellule par une particule traversant le noyau est proche de 1 pour les particules de TEL très élevé comme l'Ar de 7 MeV par nucléon (TEL = 1500 KeV/?m) ; elle n'est que de 0,02 pour les ions d'O de 400 MeV (TEL = 20 KeV/?m). L'EBR est plus élevée pour les petites doses, la relation EBR/dose étant plus marquée dans les cellules ayant un rapport ?/beta plus faible après exposition aux photons, selon le modèle linéaire-quadratique. Les particules moins efficaces que les photons en terme de mortalité cellulaire moyenne induisent des dégâts individuels importants, révélés par la production de micronoyaux (MN) multiples. Concernant le lien entre l'EBR et la radio-sensibilité intrinsèque, les données récentes utilisant à la fois la technique des colonies et la méthode des MN, montrent que l'EBR est d'autant plus élevée que les cellules sont radiorésistantes aux photons.

Courdi, A.; Pignol, J. P.; Iborra-Brassart, N.; Hérault, J.; Fares, G.; Hachem, A.; Chauvel, P.



Lamb pays lip service: two cases of ecthyma contagiosum (orf).  


Ecthyma contagiosum (orf) is caused by a parapox virus, which results in ulcerative stomatitis of mainly sheep and goats. The disease may be transmitted to humans through direct contact. Complications are rare in healthy individuals, who rarely report the disease. Two married, recreational sheep farmers, were bitten on their index fingers by an affected lamb. While the husband made an uneventful recovery after oral flucloxacillin, his wife was admitted to hospital with necrosis of her finger, cellulitis and lymphangitis requiring intravenous clindamycin. She subsequently developed a generalized maculo-papular rash, which was initially thought to be an adverse drug reaction, but, on hindsight, may have been erythema multiforme associated with orf. Orf is a common zoonosis, rarely reported in general practice. The disease is usually self-limiting and resolves in 6-8 weeks, but complications may occur. The diagnosis should be considered in at-risk occupational and religious groups. PMID:21515534

de Wet, Carl; Murie, Jill



A ?-Doped Substructure in Solar Cells: Carriers Confinement and Photocurrent  

NASA Astrophysics Data System (ADS)

This paper presents a modelling of the Low-High interfaces effects due to the implantation, in the emitter of a silicon solar cell, of a complex structure consisting of a ?-doping profile coincident with a defect layer. It leads to analytical expressions of the potential barriers and the drift electric fields due to these interfaces. The confinement of the holes generated by the infrared absorption is studied. In parallel, we propose a numerical approach for the electric phenomena occurring in the cell emitter with a complex interface: it confirms our theoretical results. The electron photocurrent due to the normal absorption is shown not to be altered by the complex structure. The hole confinement, near the front surface, can improve the performances of the cell. Both our theoretical expressions and our numerical results predict this photocurrent increase. Ce travail présente une modélisation des effets d'interfaces créés par l'implantation, dans l'émetteur d'une cellule solaire au silicium, d'une structure complexe consistant en un ?-dopage coïncidant avec une couche de défauts. Les expressions analytiques des barrières de potentiel et des champs d'entraînement montrent l'intérêt de ce ?-dopage additionnel : le confinement des trous générés par l'absorption infra-rouge ; le photocourant dû à l'absorption normale n'est cependant pas altéré par cette structure additionnelle. Une approche numérique parallèle, fondée sur les équations de transports complètes, confirme les résultats théoriques, tant au niveau du confinement des trous, que de l'amélioration des performances de la cellule sous éclairement AM1.5 : courant de court-circuit, tension de circuit ouvert et puissance maximale disponible.

Pélanchon, F.; Moreau, Y.; Mialhe, P.




PubMed Central

Purpose To ascertain if methicillin-resistant Staphyloccocus aureus (MRSA) ophthalmic infections are increasing. Methods A retrospective review of all patients with a culture positive for MRSA in the Parkland Health and Hospital System, the urban public healthcare system for Dallas County, Texas, for the years 2000 through 2004 was performed. Patients with ocular, orbital, and ocular adnexal infection were identified, and isolates were categorized as nosocomial or community-acquired (CA). Results A total of 3,640 patients with a culture positive for MRSA were identified, with 1,088 patients (30%) considered to have acquired the isolate via nosocomial transmission and 2,552 patients (70%) considered to have CA-MRSA. Forty-nine patients (1.3%) had ophthalmic MRSA involvement. For both ophthalmic and nonophthalmic cases, the number of CA-MRSA patients increased each year, whereas the numbers of nosocomial patients remained fairly constant. Patients with ophthalmic MRSA tended to be younger than other MRSA patients (P = .023). The most common manifestation of ophthalmic MRSA infection was preseptal cellulitis and/or lid abscess followed by conjunctivitis, but sight-threatening infections, including corneal ulcers, endophthalmitis, orbital cellulitis, and blebitis, also occurred. Empirical antibiotic coverage was initially prescribed in 48 (98%) of ophthalmic cases and did not adequately cover for the MRSA isolate in 24 (50%). Conclusions CA-MRSA is becoming increasingly prevalent, and ophthalmologists will see more ophthalmic MRSA infections. Although ophthalmic CA-MRSA commonly presents as preseptal lid infection and conjunctivitis, sight-threatening infections also occur. Ophthalmologists must identify MRSA patients, adjust empirical treatment regimens where MRSA is endemic, and take steps to control emergence of resistant organisms in both inpatient and outpatient practices.

Blomquist, Preston Howard



Dermatology for the practicing allergist: Tinea pedis and its complications  

PubMed Central

Tinea pedis is a chronic fungal infection of the feet, very often observed in patients who are immuno-suppressed or have diabetes mellitus. The practicing allergist may be called upon to treat this disease for various reasons. Sometimes tinea infection may be mistaken for atopic dermatitis or allergic eczema. In other patients, tinea pedis may complicate allergy and asthma and may contribute to refractory atopic disease. Patients with recurrent cellulitis may be referred to the allergist/immunologist for an immune evaluation and discovered to have tinea pedis as a predisposing factor. From a molecular standpoint, superficial fungal infections may induce a type2 T helper cell response (Th2) that can aggravate atopy. Th2 cytokines may induce eosinophil recruitment and immunoglobulin E (IgE) class switching by B cells, thereby leading to exacerbation of atopic conditions. Three groups of fungal pathogens, referred to as dermatophytes, have been shown to cause tinea pedis: Trychophyton sp, Epidermophyton sp, and Microsporum sp. The disease manifests as a pruritic, erythematous, scaly eruption on the foot and depending on its location, three variants have been described: interdigital type, moccasin type, and vesiculobullous type. Tinea pedis may be associated with recurrent cellulitis, as the fungal pathogens provide a portal for bacterial invasion of subcutaneous tissues. In some cases of refractory asthma, treatment of the associated tinea pedis infection may induce remission in airway disease. Very often, protracted topical and/or oral antifungal agents are required to treat this often frustrating and morbid disease. An evaluation for underlying immuno-suppression or diabetes may be indicated in patients with refractory disease.

Al Hasan, Muhannad; Fitzgerald, S Matthew; Saoudian, Mahnaz; Krishnaswamy, Guha



Étude des anomalies chromosomiques après radiothérapie chez des patients traités pour lymphome malin non-Hodgkinien  

NASA Astrophysics Data System (ADS)

Structural chromosome defects were evaluated in the lymphocytes of 30 patients (pts) who had undergone radiotherapy for non Hodgkin's lymphoma (NHL). Twelve had received 20 Grays (Gy) over the abdomen (group I), 12 whole body irradiation at 1.5 Gy (group II) and 6 whole body irradiation at 15 Gy (group III). A cohort of 468 unirradiated pts served as controls. For the irradiated group, 7% of cells had aberrations compared to 0.4% in controls {P <10-6}. The frequency of abnormal cells was statistically higher in group I (12%) than in group II (3.5%) and III (2.5%) . In group I, frequency of aberrations was statistically higher in pts who had additionnal extra-abdominal involved field irradiation, those with evolutive NHL and those receiving chemotherapy at the time of the cytogenetic analysis. Les aberrations chromosomiques ont ,été, mesurées sur les lymphocytes de 30 patients (pts) irradiés pour lymphome malin non-hodgkinien (LNH) selon 3 modalités : 20 Grays (Gy) sur l'abdomen (groupe I : 12 pts), Irradiation corporelle totale 1,5 Gy (groupe II : 12 pts), ou 15 Gy (groupe III : 6 pts). Une population non irradiée de 468 pts a servi de témoin. Dans le groupe irradié, 7 % des cellules présentaient des anomalies contre 0,4 % dans le groupe témoin {P <10-6}. Les aberrations ,étaient statistiquement plus nombreuses dans le groupe I (12 % des cellules) que dans les groupes II (3,5 %) et III (2,5 %). Dans le groupe I, les anomalies , étaient statistiquement plus fréquentes chez les pts ayant eu une irradiation localisée extra-abdominale en complément de celle de l'abdomen ainsi que chez ceux en rechute de leur LNH et ceux recevant une chimiothérapie lors de l',étude cytogénétique.

Mahe, M. A.; André, M. J.; Moyon, E.; Le Mevel, A.; Soubeyran, P.; Hamidou, M.; Milpied, N.; Bourdin, S.; Cuillière, J. C.; Chatal, J. F.



Complicating osteomyelitis imaged with Tc-99m MDP, In-111 granulocytes, and Ga-67 citrate  

SciTech Connect

Gallium-67 and 3-phase bone scan (3P) studies, though very sensitive, are not very specific in evaluating suspected osteomyelitis (OM) which is superimposed upon other diseases that cause increased bone turnover (IBT). The authors compared In-111 acetylacetone labeled granulocytes (In-111) GRAN) with 3P in 57 such patients; 29 of these patients had Ga-67 studies as well. In-111 GRAN had a sensitivity of 100% in acute OM, 62% in chronic OM, and a specificity of 96%. Gallium-67 ruled out OM when the study was normal; it diagnosed OM when the relative uptake of Ga-67 exceeded the uptake of Tc-99m MDP, or when the skeletal distribution of Ga-67 was different from that of the TC-99m MDP. Unfortunately, these criteria were met in only 28% of the subjects. The simple approach of increased Ga-67 activity meant OM gave a sensitivity of 100%, but an unacceptable specificity of 38%. Chronic cellulitis or long-standing decubiti were seldom detected by IN-111 GRAN. Clinically obvious soft tissue infections or cellulitis were seen with In-111 GRAN 27% of the time, and 17% of the time with Ga-67. The authors conclude that when added to 3P, In-111 GRAN provided more useful information than did Ga-67. A combination of all 3 studies did not significantly increase the diagnostic yield. Performing In-111 GRAN without 3P in patients with IBT is not recommended since the 3P provides anatomic information that aids in the differentiation of OM from soft tissue infections.

Schauwecker, D.S.; Park, H.M.; Mock, B.H.; Burt, R.W.; Kernick, C.B.; Ruoff, A.C. III; Sinn, H.J.; Wellman, H.N.; Vamc, R.L.R.



A pin in appendix within Amyand's hernia in a six-years-old boy: case report and review of literature  

PubMed Central

Introduction Presence of vermiform appendix (non-inflamed or inflamed) in inguinal hernia is called Amyand's hernia in honor to surgeon C. Amyand who published the first case of perforated appendicitis within inguinal hernia in a boy caused by ingested pin. This presentation of foreign body Amyand's hernia appendicitis is very rare, and here we present such a case. Case presentation A 6-year-old boy, white Kosovar ethnicity, presented with right groin pain, swelling and redness. Two days before admission the patient was injured by football during a children game in the right lower abdomen and the next day he complained of pain in the right inguinal area. On admission patient had a painful non-reducible mass in the right inguinal region and cellulitis. Plain abdominal x-ray showed no fluid-air levels, but a metallic foreign body (pin) under right superior pubic ramus was apparent. With preoperative diagnosis of suspect incarcerated inguinal hernia with cellulitis the patient was operated on under general anaesthesia in December 2, 2006. Intraoperatively we found the inflamed vermiform appendix perforated by a pin in the hernial sac. Appendectomy and herniotomy were performed. The wound was primary closed, without any post-operative complications and follow up for the patient is three years long. Conclusion Foreign body (pin) Amyand's hernia appendicitis seems to be extremely rare, maybe once in a century (Amyand 1735, Hall 1886, and our case in 2006). In patients with clinical signs of incarcerated inguinal hernia, with locally inflammatory signs, but without signs of intestinal obstruction Amyand's hernia appendicitis in differential diagnosis must be considered. In our case, it is possible that the injury during the football game might have induced perforation of the vermiform appendix with the foreign body in it.



Group G Beta-Hemolytic Streptococcal Bacteremia Characterized by 16S Ribosomal RNA Gene Sequencing  

PubMed Central

Little is known about the relative importance of the four species of Lancefield group G beta-hemolytic streptococci in causing bacteremia and the factors that determine the outcome for patients with group G beta-hemolytic streptococcal bacteremia. From 1997 to 2000, 75 group G beta-hemolytic streptococcal strains were isolated from the blood cultures of 66 patients. Sequencing of the 16S rRNA genes of the group G beta-hemolytic streptococci showed that all 75 isolates were Streptococcus dysgalactiae subspecies equisimilis. The API system (20 STREP) and Vitek system (GPI) successfully identified 65 (98.5%) and 62 (93.9%) isolates, respectively, as S. dysgalactiae subspecies equisimilis with >95% confidence, whereas the ATB Expression system (ID32 STREP) only successfully identified 49 isolates (74.2%) as S. dysgalactiae subspecies equisimilis with >95% confidence. The median age of the patients was 76 years (range, 33 to 99 years). Fifty-six patients (85%) were over 60 years old. All patients had underlying diseases. No source of the bacteremia was identified (primary bacteremia) in 34 patients (52%), whereas 17 (26%) had cellulitis and 8 (12%) had bed sore or wound infections. Fifty-eight patients (88%) had community-acquired group G streptococcal bacteremia. Sixty-two patients (94%) had group G Streptococcus recovered in one blood culture, whereas 4 patients (6%) had it recovered in multiple blood cultures. Fifty-nine patients (89%) had group G Streptococcus as the only bacterium recovered in their blood cultures, whereas in 7 patients other bacteria were recovered concomitantly with the group G Streptococcus in the blood cultures (Staphylococcus aureus in 3, Clostridium perfringens in 2, Citrobacter freundii in 1, and Bacteroides fragilis in 1). Overall, 10 patients (15%) died. Male sex, diagnosis other than cellulitis, hospital-acquired bacteremia, and multiple positive blood cultures were associated with mortality {P < 0.005 (relative risk [RR] = 7.6), P < 0.05 (RR = 3.7), P < 0.005 (RR = 5.6), and P < 0.05 (RR = 5.6), respectively}. Unlike group C beta-hemolytic streptococcal bacteremia, group G beta-hemolytic streptococcal bacteremia is not a zoonotic infection in Hong Kong.

Woo, Patrick C. Y.; Fung, Ami M. Y.; Lau, Susanna K. P.; Wong, Samson S. Y.; Yuen, Kwok-Yung



Critical boiling phenomena observed in microgravity  

NASA Astrophysics Data System (ADS)

We report experimental observations of the critical boiling when co-existing gas and liquid phases of pure fluid are heated under weigthlessness through the critical point. We find that when the system's temperature T is being increased to the critical temperature Tc so that it's slightly out of equilibrium, the apparent contact angle becomes very large (up to 110 circ). The gas appears to "web" the solid surface. In addition, we detect large temperature gradients between the (hot) gas phase and the (cold) liquid phase in the interferometric cell. These unexpected results are robust: they are observed either under continuous heating (ramping) or stepping by positive temperature quenches, for various morphologies of the gas bubble and in different fluids (SF6 and CO2). The difference in isentropic thermal responses of gas and liquid during heating, due to the adiabatic heating by the "Piston Effect", is responsible for the temperature non-homogeneities. The vapour recoil force due to liquid evaporation, which is involved in the boiling crisis in heat exchangers, is presumably at the origin of the interface deformation. Nous rapportons les observations expérimentales obtenues en chaffant un fluide pur diphasique gaz-liquide en coexistence au cours de la traversée de son point critique en absence de pesanteur. Lorsque la température du système diphasique hors d'équilibre est augmentée vers la température critique, nous observons en transmission un angle de contact apparent de la vapeur très important (atteignant 110 circ), le gaz semblant "mouiller" la surface solide. De plus, d'importants gradients de température entre la phase gaz chaude et la phase liquide froide sont mesurés dans les cellules observées par interférométrie. Ces résultats inattendus sont observés pour un chauffage continu (rampe) et par trempe positive (échelon), pour différents rapports d'aspect du système diphasique, pour des cellules de CO2 et de SF6, démontrant ainsi une grande robustesse. Les réponses isentropiques différentes du gaz et du liquide lors du chauffage par effet piston sont certainement responsables des inhomogénéités de température. La force de recul de la vapeur due à l'évaporation pourrait être la cause dominante de la déformation de l'interface liquide-vapeur à l'approche de la température de transition.

Garrabos, Y.; Chabot, C.; Wunenburger, R.; Delville, J.-P.; Beysens, D.



Cellular effects produced by internal contamination of rats with tritiated water  

NASA Astrophysics Data System (ADS)

The activity of the erythrocyte glucose-6-phosphate dehydrogenase (G6PDH) and the thymidine (TdR) incorporation in the bone marrow cells have been investigated in rats internally contaminated with tritiated water (HTO). The total doses (4.2cGy; 19.4cGy and respectively 5cGy; 20cGy) were delivered as chronic (100days) and acute (5 days) contamination. It was observed a significant increase of Glucose-6-Phosphate- Dehydrogenase (G6PDH) activity for 4.2cGy (0.4mGy/day). Both types of contamination produced the reduced incorporation of TdR in the bone marrow cells. These results would allow us to speculate that the reduction of the TdR incorporation could be determined by the changes at the level of membrane transport functions for the lower doses (4.2cGy; 5cGy), and by radiation induced phenomena at the intracellular level for the larger doses (19.4cGy; 20cGy). Nous avons etudié les effets de l'irradiation des rats par contamination interne à l'eau tritiée, sur l'activité enzymatique de glucose-6-phosphate deshydrogénase (G6PDH) érytrocytaire et sur l'incorporation de thymidine (TdR) dans des cellules de la moelle osseuse. Les doses accumulées par contamination chronique (100 jours) sont 4.2 cGy et 19.4 cGy et par contamination aiguë (5 jours) sont 5 cGy et 20 cGy. Nous avons observé une augmentation significative de l'activité de la Glucose-6-Phosphate-Dehydrogenase (G6PDH) pour la dose d'irradiation de 4.2 cGy (0.04 cGy/jour). Les deux types de contamination ont induit la diminution de l'incorporation de TdR dans les cellules de la moelle osseuse. Ces résultats suggèrent que la diminution de l'incorporation de TdR peut être liée à des modifications au niveau du transport transmembranaire pour des irradiations chronique de 4.2 cGy et aiguë de 5 cGy. Des phénomènes radioinduites intracellulaires sont probablement à l'origine de la diminution de l'incorporation de TdR pour les doses de 19.4 cGy et 20 cGy.

Savu, D.; Moisoi, N.; Petcu, I.



A Study on the Acute Kidney Injury in Snake Bite Victims in A Tertiary Care Centre  

PubMed Central

Introduction: Snake bite is a common medical emergency and an occupational hazard, more so in tropical India, where farming is a major source of employment. Viper bites are more common than other poisonous snakebites in humans. The World Health Organization has estimated that there are approximately 1,25,000 deaths among 2,50,000 poisonous snake bites worldwide every year, of which India accounts for 10,000 deaths. Acute kidney Injury (AKI) is an important consequence of a snake bite and its proper supportive management after the anti-venom administration is of utmost importance, for a good patient outcome. Aims and Objectives: 1. To assess the risk factors and the prognostic factors in snake-bite induced Acute Kidney Injury.2. To determine the outcome of snake bite patients with AKI in a tertiary care centre in Karnataka, India. Methodology: This prospective study was carried out at Vijaynagar Institute of Medical Sciences, Bellary, Karnataka, India. This institute is a referral government hospital in north Karnataka, India. Study Design: This was a prospective and descriptive type of study. Results: A total of 246 cases of venomous snakebite were included in this study, who were admitted in the hospital from November 2007 to October 2008. Among the AKI and the non-AKI patients, Illiteracy was more among the patients who suffered from AKI (75%). In our study, among all the patients (both AKI and non-AKI patients), viper bite was the commonest and it was seen in 31(91.6%) cases among the AKI patients and in 142 (67.6%) cases among the non-AKI patients. In our study, a majority of the patients who developed AKI had initially visited traditional healers before visiting our hospital, which was found to be statistically significant. In the present study, disseminated intravascular coagulation (DIC) and intravascular haemolysis were found to be predominant among the AKI patients. The “Bite to Needle” time was significantly more in the patients who developed AKI as compared to that in those who developed non-AKI. Out of 36 patients who suffered from AKI, 28 (77.7%) patients survived. Among them, 27(96.7%) patients developed cellulitis, 25(89.5%) had regional lymphadenopathy, 22(81.2%) were bitten at their lower limbs, and 6 (23.8%) patients developed bleeding manifestations. Conclusion: This study concludes that acute kidney injury occurs in 14.6% of the victims of snake bite. The common manifestations include cellulitis, bleeding manifestations and gangrene at the site of the bite.

L, Harshavardhan; A J, Lokesh; H L, Tejeshwari; B R, Halesha; Metri, Siddharama S



Évolution nycthémérale des composantes biochimiques du phytoplancton de la retenue du barrage Idriss premier (Fès, Maroc)  

NASA Astrophysics Data System (ADS)

The diel changes of the biochemical composition of the phytoplankton were studied in the Idriss first reservoir (located on the Inaouen river at thirty Km from the city of Fes, Morrocco) during September 1994. Several biomass and metabolic indicators (proteins, carbohydrates, lipids, chlorophyll a and primary production) were assessed every fourth hour over tow days (7, 8 and 9 September). Since the Protein/Carbohydrates ratio (P/C) is largely recognised as a good integrator of the metabolic functions of the cells, we examined its distribution pattern concomitantly with aforementioned parameters. The results demonstrated enhanced P/C ratios clearly indicating that nutrients were sufficiently available for growth. In addition, this index showed a diel significant variation with levels higher in the night than in the day. Moreover, these results suggest that phytoplankton species during the night used the day-synthesised carbohydrates to insure the cell metabolic functioning. The P/C presents relatively high values in proposition to the ones that have been recorded in temperate regions, and seems to be related to azotic inputs of the Inaouen river. Dans le but de parfaire nos connaissances sur le fonctionnement du sous écosystème phytoplancton, nous nous sommes intéressés à étudier son cycle nycthéméral et son métabolisme cellulaire dans la retenue du barrage Idriss premier. Cette dernière, construite sur l'Oued Inaouène, est située à une trentaine de Km de la ville de Fès. Au cours de ce cycle, les prélèvements ont été effectués selon une séquence temporelle de 4 heures pendant 48 heures, les 7, 8 et 9 septembre 1994. L'étude de l'évolution des composantes biochimiques des cellules phytoplanctoniques à savoir les protéines, les glucides et les lipides a permis de mettre en évidence des variations nycthémérales importantes. Ces variations sont d'autant plus importantes que les variations spatiales observées entre les profondeurs. De plus, le rapport protéines/glucides (P/G), reconnu comme un bon indicateur de l'état physiologique des algues, présente des valeurs plus élevées la nuit que le jour au niveau du fond du lac. Ce résultat suggère que le phytoplancton utilise les produits de réserve synthétisés le jour pour assurer le fonctionnement métabolique des cellules. De plus, les valeurs de ce rapport sont relativement élevées par rapport à celle enregistrées dans les régions tempérés et semblent être liées aux ressources azotées du milieu en particulier les apports de l'Oued Inaouène.

Bahhou, J.; Alaoui Mhamdi, M.



Infectious complications of noncombat trauma patients provided care at a military trauma center.  


Infectious complications are reported frequently in combat trauma patients treated at military hospitals. Infections in 4566 noncombat related trauma patients treated at a military trauma center were retrospectively reviewed from 1/2003 to 5/2007 using registry data. Burns, penetrating, and blunt trauma accounted for 17%, 19%, and 64%, respectively; the median age was 38 and 22% were female. Pulmonary infections were present in 4.2% of patients, 2.4% had cellulitis and wound infections, 2.2% urinary infections, and 0.7% sepsis. On univariate analysis, infected patients were more likely to be admitted to the ICU, have longer ICU and hospital lengths of stay (LOS), and to die (p < 0.05). Multivariate analysis revealed associations between infection and hospital LOS, preexisting medical conditions, and lower Glasgow Coma Scale in nonburned patients. In burned patients, infection was associated with total body surface area burned and preexisting conditions (p < 0.01). Enhanced infection control in targeted trauma populations may improve outcomes. PMID:20486502

Yun, Heather C; Blackbourne, Lorne H; Jones, John A; Holcomb, John B; Hospenthal, Duane R; Wolf, Steven E; Renz, Evan M; Murray, Clinton K



Kodamaea ohmeri fungemia in an immunocompetent patient treated with micafungin: case report and review of the literature.  


Kodamaea (Pichia) ohmeri is an unusual yeast-form fungus that has recently been identified as an important etiology of fungemia, endocarditis, cellulitis, funguria and peritonitis in immunocompromised patients. We report a case of K. ohmeri fungemia in a 34-year-old hospitalized patient with thrombophlebitis. The patient was admitted to the hospital for evaluation and management of an acquired tracheo-esophageal fistula secondary to an impacted denture. Fever developed on hospital day 22, and physical exam revealed right arm superficial thrombophlebitis at the site of the peripheral venous catheter that was confirmed by Doppler ultrasound. The peripheral vein was removed and blood cultures from hospital day 22 and 23 grew yeast species. The yeast was subsequently identified to be K. ohmeri by Vitek II and API20C and was confirmed by 18S rRNA gene sequencing. The fungemia and right arm phlebitis was successfully treated with a 2-week course of micafungin therapy. This is the first case of K. ohmeri fungemia in a patient that was successfully treated with micafungin. PMID:20449770

Shaaban, Hamid; Choo, Hoo Feng; Boghossian, Jack; Perez, George



Neutrophilic and eosinophilic dermatitis caused by contact allergic reaction to paraphenylenediamine in hair dye.  


BACKGROUND Paraphenylenediamine (PPD) in hair dyes can cause systemic as well as cutaneous allergic reactions such as neutrophilic and eosinophilic dermatitis. The symptoms are often severe. The acute lesion is normally histologically indistinguishable from any eczematous reaction with marked spongiosis. OBSERVATIONS We report a case of allergic contact dermatitis caused by the use of hair dye containing PPD that developed in a patient who had been using the same hair dye for many years. Her symptoms included scalp dermatitis and widespread skin lesions as well as lymphadenopathy and quite possibly dyspnea resembling asthma. What is most remarkable about this case is the histopathologic finding of neutrophilic cellulitis and a marked neutrophilic infiltrate with variable spongiosis. This unique finding was confirmed by histologic analysis of a patch test lesion specimen. CONCLUSION It is always important to consider contact allergic dermatitis as a cause of dermatitis because of the variable presentation of the disease, including unique histologic findings that do not fit the conventional picture, as in the present case. PMID:23165836

Lönngren, Vincent; Young, Ewa; Simanaitis, Mecius; Svedman, Cecilia



Receipt of Care and Reduction of Lower Extremity Amputations in a Nationally Representative Sample of U.S. Elderly  

PubMed Central

Objective To determine effectiveness of receipt of care from podiatrist and lower extremity clinician specialists (LEC specialists) on diabetes mellitus (DM)-related lower extremity amputation. Data Sources Medicare 5 percent sample claims, 1991–2007. Study Design Individuals with DM-related lower extremity complications (LECs) were followed 6 years. Visits with podiatrists, LEC specialists, and other health professionals were tracked to ascertain whether receipt of such care reduced the hazards of an LEC amputation. Data Collection Individuals were stratified based on disease severity, Stage 1—neuropathy, paresthesia, pain in feet, diabetic amyotrophy; Stage 2—cellutis, charcot foot; Stage 3—ulcer; Stage 4—osteomyelitis, gangrene. Principal Findings Half the LEC sample died within 6 years. More severe lower extremity disease increased risk of death and amputation. Persons visiting a podiatrist and an LEC specialist within a year before developing all stage complications were between 31 percent (ulceration) and 77 percent (cellulitis and charcot foot) as likely to undergo amputation compared with individuals visiting other health professionals. Conclusions Individuals with an LEC had high mortality. Visiting both a podiatrist and an LEC specialist in the year before LEC diagnosis was protective of undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care.

Sloan, Frank A; Feinglos, Mark N; Grossman, Daniel S



Complications and outcomes of brown recluse spider bites in children.  


Brown recluse spider bites may cause severe local and systemic morbidity, but data regarding morbidity in children are limited. This study reviewed inpatient medical records (n = 26; 10 years) with a discharge diagnosis of "spider bite" from a tertiary pediatric hospital. The majority (85%) of children had an inflammatory response accompanying necrosis, usually with signs of secondary cellulitis (77%). Hemolytic anemia (50%), rhabdomyolysis (27%), and acute renal failure (12%) were the most prevalent systemic effects. Hemolytic anemia was bimodal in distribution relative to the time-of-onset of the bite (early, 2.2 ± 0.4; late, 6.9 ± 1.5 days postbite, respectively; P = .004). Although no fatalities occurred in the population, 65% of children had major morbidity, including wound complications requiring surgical care and acute orbital compartment syndrome. The findings emphasize the importance of anticipatory patient/family education for outpatients and careful monitoring for systemic morbidity in inpatients. Timely and appropriate supportive care should yield favorable outcomes in most cases. PMID:21307081

Hubbard, Jonathan J; James, Laura P



[Benign subcutaneous emphysema after nail penetration : Case report and important differential diagnoses.  


Crepitus under the skin after penetrating injuries: harmless benign subcutaneous emphysema or life-threatening infection with gas-producing bacteria (gas gangrene because of Clostridium perfringens, crepitating cellulitis because of anaerobic Streptococcus or other coliforme bacteria)?We report a case of a 74-year-old male who developed massive crepitation of the left upper extremity and the lateral thoracic wall and mediastinal emphysema after sustaining a laceration of the left thumb and forefinger from a nail. Because there was the suspicion of gas gangrene we performed generous skin incisions of the ventral and dorsal part of the hand, the forearm and upper arm and open wound treatment. A triple antibiotic therapy was initiated. Due to fast regression of the subcutaneous emphysema and the mediastinal emphysema, continuing lack of symptoms, negative smear test results from the beginning and low infection parameters in the blood all wounds could be closed 9 days after primary surgery. The suspicion of gas gangrene was not confirmed so the diagnosis of benign subcutaneous emphysema was made. PMID:23703620

Kantelberg, C; Meyer, C; Harland, U



Complications of nephrotic syndrome.  


Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS. PMID:22087198

Park, Se Jin; Shin, Jae Il



Hyalohyphomycosis caused by Paecilomyces lilacinus after kidney transplantation.  


Hyalohyphomycosis caused by Paecilomyces has rarely been described among solid organ recipients. Its management is elusive without an established consensus concerning antifungal therapy. Herein we have reported a case of extensive cellulitis caused by Paecilomyces lilacinus observed in a 48-year-old kidney transplanted woman with hepatitis C. Kidney transplantation from a cadaveric donor was performed in October 2006 with an uneventful early course except for posttransplant diabetes mellitus and a reversible acute rejection episode. Cutaneous nodular and verrucous lesions of the left leg appeared in August 2007. In a few weeks, these lesions become ulcerated, hemorrhagic, and painful. The diagnosis was made on the basis of microbiologic culture and histological examination. There was no improvement in the skin lesions after 6 weeks treatment with itraconazole, but voriconazole yielded a good response within the first 2 weeks. There was a good tolerance to antifungal therapy; graft function and liver tests remained normal. We concluded that an increasing emerging of fungal infections is observed with the introduction of more powerful immunosuppressive drugs. Diagnosis and management of such infections is elusive. Preventive measures should be considered including the adaptation of immunosuppressive therapy among at-risk patients especially those with hepatitis C virus infection and diabetics. PMID:19765473

Ounissi, M; Abderrahim, E; Trabelsi, S; Khaled, S; Bezzine, H; Ben Hamida, F; Hedri, H; Ben Abdallah, T; Ben Maïz, H; Kheder, A



Preliminary results of a phase I/II clinical trial using in situ photoimmunotherapy combined with imiquimod for metastatic melanoma patients  

NASA Astrophysics Data System (ADS)

In Situ Photoimmunotherapy (ISPI), a newly developed modality for cancer therapy, has been shown to be able to modulate the body's own immune response. This clinical trial was designed to evaluate the safety and therapeutic effect of ISPI, using imiquimod as its immunoadjuvant for metastatic melanoma patients. ISPI consisted of three main components applied directly to the cutaneous metastases: 1) local application of topical imiquimod; 2) injection of indocyanine green; and 3) an 805 nm laser for local irradiation. All patients completed at least one cycle of treatment. All the patients completed at least one cycle of treatments; one patient received 6 cycles. The most common adverse effects were rash, pruritus, pain, fatigue and anorexia. Fever, chills, vomiting and cellulitis were relative rare. No grade 4 toxicity was observed. Complete Response (CR) was observed in 6 patients. Median overall survival of the 11 evaluated patients was 12.2 months. Six of the eleven patients were still alive at the time of this report. Treatment of ISPI using imiquimod is safe and well tolerant. Our preliminary clinical results suggest that this new method can be a promising modality for metastatic melanoma.

Li, Xiaosong; Naylor, Mark F.; Nordquist, Robert E.; Teague, T. Kent; Howard, C. Anthony; Murray, Cynthia; Chen, Wei R.



Arthroscopic management of septic arthritis of temporomandibular joint.  


This article reports on 7 patients with septic arthritis of the temporomandibular joint (TMJ) who were managed with arthroscopy between 1998 and 2007. The common symptoms were trismus and pain. A series of imaging studies showed widening of joint space in 1 patient with plain film; MRI demonstrated increased joint effusion in 4 patients; accompanying cellulitis in adjacent tissues was discerned by CT in 2 patients. Under the arthroscope, a reddened and swollen synovial membrane was found in 2 patients who were in the acute stage, whereas strong adhesions, destruction of cartilage, and bony defects were discovered in other 5 patients in the chronic stage. Additionally, the disc was ruptured in 3 patients, and fibrosis was confirmed for 2 patients. Lavage, lysis of adhesion, and debridement of articular surface were common procedures for treatments. The average follow-up period was 57.4 months, and no recurrence was found. Arthroscopy has proven to be a useful method for management of septic arthritis of TMJ, especially for patients in the chronic stage. PMID:20123377

Cai, Xie-Yi; Yang, Chi; Chen, Min-Jin; Zhang, Shan-Yong; Yun, Bai



Methicillin Resistant Staphylococcus Aureus Infection as a causative agent of fistula formation following total laryngectomy for advanced head & neck cancer  

PubMed Central

Aims The purpose of this paper was to investigate the impact of Methicillin Resistant Staphylococcus Aureus (MRSA) infection in the aetiology of pharyngo-cutaneous fistula (PCF) formation following total laryngectomy for advanced laryngeal cancer. Methods This was a retrospective uncontrolled case study series of 31 consecutive patients based in a single institution tertiary referral head and neck oncology centre. Results Pharyngo-cutaneous fistulas (PCF) following total laryngectomy occurred in 10 (32%) patients. MRSA was identified in 80% of patients with a PCF compared to 9% of patients that did not develop a fistula (p = 0.0001255 Fisher exact test). MRSA infection (p = 0.00012) and previous radiotherapy (p = 0.00025) were the only significant factors found to be important in fistula formation on multivariate analysis. Post-operative infections such as cellulitis, chest infection and carotid fistula were also associated with MRSA infections. Conclusion MRSA infection following total laryngectomy for laryngeal cancer can lead to potential serious complications such as PCF. Patients who underwent total laryngectomy following radiotherapy failure are at a higher risk of acquiring MRSA.




PubMed Central

Background: Fever is the most common sign of childhood illnesses and febrile children constitute a substantial proportion of the practice of pediatrics and family medicine. Objectives: To highlight the pattern of febrile illnesses in children attending pediatric ambulatory health-care settings. Methods: A one-year prospective study was conducted on febrile children who were consecutively seen and managed at two walk-in primary-care clinics in Sulaimania Children's Hospital, Riyadh. Data collection and analysis were structured around the principal study objectives. Results: Among the 16,173 children seen, 4086 (25.3%) were identified as having a fever and evaluated to determine the aetiology of their febrile illness. Boys outnumbered girls and a significant increase in the frequency of febrile illnesses was noted in children 4 to 24 months of age. Upper respiratory tract infections were the commonest cause of fever (75%) and most of these infections were viral rhinopharyngitis. Viral gastroenteritis and pneumonia were prominent diagnoses, each accounting for 5% of febrile illnesses. Notably of low frequency were serious bacterial infections, such as meningitis (0.5%), cellulitis and bone or joint infection (1.8%) and urinary tract infection (0.7%). Only 9% of the febrile children required hospitalization. The ambulatory management of the other febrile children included the prescription of oral antibiotics to 64% of them. Conclusion: The proper clinical assessment of these febrile children and the prudent use of laboratory tests and antimicrobials remain the most important management strategies in primary health-care practice.

Al-Eissa, Youssef A; Ghazal, Sameeh S.; Al-Zamil, Fahad A.; Al-Salloum, Abdullah A.; Al-Omair, Abdullah O.; Al-Nasser, Mohammed N.



The prevalence and nature of podiatric problems in elderly diabetic patients.  


To determine if diabetes in the elderly is associated with increased prevalence of podiatric problems, a random sample of diabetic patients (n = 74) was compared to a group of elderly non-diabetic patients (n = 79). The two groups were comparable in age (range 70-90 years), smoking habits, and consumption of alcohol. The mean duration of diabetes was 14.5 +/- 11.7 years (+/- SD), and mean serum fructosamine level was 3.3 +/- 0.66 mmol/L. The number of medical diagnoses and medications used was significantly higher in the diabetic group. Diabetic patients had modestly higher prevalence of neuropathy, vascular disease, kidney disease, and eye complications. The most common podiatric problem in both groups was elongated toenails. The prevalence of podiatric problems such as cellulitis, amputation, tinea pedia, onychomycosis, calluses, bunions, and hammer toe deformity were not increased in diabetic patients. Active foot ulcers were more common in diabetic patients (13/74 vs 5/79, P less than 0.05). It is concluded that diabetes in the elderly, unlike in young patients, increases the risk of foot problems only marginally. PMID:2005336

Evans, S L; Nixon, B P; Lee, I; Yee, D; Mooradian, A D



Orbital mucormycosis in an immunocompetent individual  

PubMed Central

Background Orbital mucormycosis caused by Zygomycetes is a rare and fatal infection that generally affects the patients who are immunocompromised. Despite antifungal therapy and aggressive surgical intervention, mucormycosis can cause serious and rapidly fatal infections if delayed diagnosis or therapeutic management occurs. Here, we report orbital mucormycosis in a healthy boy, with a favorable outcome after aggressive treatment. He has had no recurrence since the end of his treatment. Case present A 2-year old healthy boy, some days after entry of dust particle to his left eye presented with swelling and redness of the eye. With diagnosis of “periorbital cellulitis” intravenous antibiotics vancomycin (40 mg/kg/day) and ceftriaxone (75 mg/kg/day) were started but no improvement was observed. The results of biopsy and tissue culture led us to a diagnosis of mucormycosis. Orbital exenteration, combined with intravenous amphotericin B (1 mg/kg/day), resulted in the patient's survival. Conclusion Due to the high mortality rate of mucormycosis, early diagnosis based on clinical findings and biopsy could be effective for management of the patients suffering from this infection.

Badiee, P; Jafarpour, Z; Alborzi, A; Haddadi, P; Rasuli, M; Kalani, M



Hand injuries secondary to subcutaneous illicit drug injections.  


We present a retrospective analysis of 32 patients admitted over a 5-year period to a metropolitan regional trauma center with recently induced subcutaneous ("skin pop") illicit drug injectional injuries involving the hand. Cocaine derivatives were the most frequently reported illicit drug used (75%). All patients had local disease manifested by subcutaneous abscess formation, and several had regional disease (cellulitis, lymphangitis, or lymphadenopathy), but only one patient had systemic illness. Microbiological analysis revealed endogenous integumentary and oral flora sensitive to oral preparations of several antibiotic medications including cephalosporins. Primary therapy included intravenous administration of antibiotic medications in all instances and simple incision and drainage under local anesthesia in 26 patients (81%). Six patients (19%) required more radical operative therapy. All patients were hospitalized and recovered without sequelae, with preservation of hand function after follow-up evaluation, which ranged from weeks to months, except for 1 patient who required digital amputation because of necrosis. Although the issue of compliance in terms of wound and general medical care for this patient population is problematic, analysis of the data suggested that patients with illicit drug injectional injuries of the hand confined to subcutaneous regions could be effectively and safely managed in outpatient settings by simple wound care and orally administered cephalosporin medications. PMID:7702297

Thomas, W O; Almand, J D; Stark, G B; Parry, S W; Rodning, C B



Serum zinc levels and their relationship with diseases in racehorses.  


Zinc is one of the essential microelements involved in the regulation of enzyme activity, as well as metabolism of nucleic acid and proteins. There have been few reports on equine serum zinc concentrations during the training period, and little is known about the relationship between zinc levels and diseases in horses. In this study, we measured serum zinc levels in healthy Thoroughbred racehorses, as well as in other horses, under general disease or training conditions. The reference value for serum zinc levels in Thoroughbred horses was 41-79 ?g/dl. There were no differences in serum zinc levels due to sex or age. Significant decreases in serum zinc levels were observed after training, but serum zinc levels did not vary with intensity of sweating. Serum zinc levels were lower in horses clinically diagnosed as having shipping fever (36.3 ± 2.7 ?g/dl), fever (45.3 ± 3.0 ?g/dl) and cellulitis (44.0 ± 3.4 ?g/dl), as compared to control values (59.7 ± 9.7 ?g/dl). They also tended to decrease in experimentally infected horses one day after inoculation. Changes in serum zinc levels reached nadir one day after surgical invasion, except for a horse that experienced complicating shock. These results suggest that zinc is a serological indicator of inflammatory status in Thoroughbred horses. PMID:22972467

Murase, Harutaka; Sakai, Satoshi; Kusano, Kanichi; Hobo, Seiji; Nambo, Yasuo



Solitary necrotic nodule of the liver misinterpreted as malignant lesion: considerations on two cases.  


In our experience, we document 2 cases of a rare and non-tumoral lesion of the liver misinterpreted as necrotic tumor: necrotic solitary nodule. In the first clinical case, ultrasound (US) showed a polylobated lesion (35 x 35 x 38 mm) at segment 8. Color-doppler identified a compression of celiac axis (Dunbar syndrome). Arteriography revealed a subtotal stenosis of celiac tripod soon after the emergence of the left gastric artery. FNAB-CT showed a highly cellulated tissue with a necrotic core surrounded by a fibersclerotic tissue. The patient underwent surgery: cholecystectomy and correction of Dunbar syndrome. US follow-up showed a progressive reduction in diameter of the lesion (24 x 25 x 25 mm at 24 months), suggesting in this case the role of ischemic injury in the pathogenesis of the lesion. In the second clinical case, a hypoechoic lesion (32 x 32 x 30 mm) of segment 6 as occasional US finding during the staging for prostate cancer was shown. FNAC-CT showed a positive result for necrotic cells. Surgical treatment consisted in a wide excision of the lesion. Histologically the lesion was solitary necrotic nodule. The diagnosis of this rare lesion is accidental. In accordance with the literature (50% of cases), we founded an associated tumor. Radiology doesn't differentiate solitary necrotic nodule and other solid lesions. Diagnosis is histological (in our second case, FNAC-CT misinterpreted the tumor as a malignant lesion, while histology showed the real nature of it). PMID:10951422

De Luca, M; Luigi, B; Formisano, C; Formato, A; De Werra, C; Cappuccio, M; Loffredo, A; Forestieri, P



Efficacy of Antibiotic-Impregnated Polymethylmethacrylate Beads in a Rhesus Macaque (Macaca mulatta) with Osteomyelitis  

PubMed Central

Here we describe the successful surgical implementation of antibiotic-impregnated polymethylmethacrylate beads in a rhesus macaque (Macaca mulatta) with marked osteomyelitis. The macaque presented to the veterinary clinic with grossly contaminated bite wounds in the left ankle secondary to conspecific trauma. Radiographic findings were highly suggestive of osteomyelitis. Additional differential diagnoses included bony infarct, fracture, and cellulitis. In light of the location of the lesion and extensive tissue trauma, the animal had a poor prognosis. Systemic, broad-spectrum antibiotics were instituted. After 2 wk of care, lesions did not respond to empirical therapies. On consultation, a veterinary orthopedic surgeon at another facility recommended placement of antibiotic-impregnated polymethylmethacrylate beads at the sites of osteomyelitis. The animal underwent minor surgery in which beads were introduced into the wound. The monkey had a positive response to therapy. The animal regained full function and was returned to outdoor social housing. Veterinarians are encouraged to consider using antibiotic-impregnated polymethylmethacrylate beads when treating osteomyelitis in other nonhuman primates and in other traditional laboratory animal species.

Kelly, Kristi R; Kapatkin, Amy R; Zwingenberger, Allison L; Christe, Kari L



Comparison of Recurrence Rates in Obese and Non-Obese Patients Undergoing Ventral Hernia Repair with Lighter-Weight, Partially Absorbable Mesh.  


Lighter-weight, large pore meshes with absorbable layers are designed for intra-abdominal placement in laparoscopic ventral hernia repair. This retrospective review of 86 patients who underwent ventral hernia repair with PROCEED? Surgical Mesh (Ethicon, Inc., Somerville, NJ) represents an evaluation of a cohort of patients implanted with this mesh. All patients implanted with PROCEED Mesh for ventral hernia repair between October 2006 and December 2007 were contacted and asked to participate in an evaluation of their hernia repair. Patients were evaluated for pain, recurrence of their hernia and other potential complications. Eight patients underwent open repair; all others were performed laparoscopically. One patient continued to have pain at 1 year. Twelve developed seromas early on and 5 required drainage by a single puncture each. None persisted. There were 4 recurrences with none in patients with a Body Mass Index 3 32. One case of abdominal wall cellulitis responded to antibiotics. There were no wound infections, mesh infections, bowel obstructions or enteric fistulas. This study demonstrates the utility of a lighter-weight, large pore, partially absorbable mesh for intraperitoneal use in laparoscopic ventral hernia repair and indicates this mesh is strong enough for use in obese patients. PMID:22504983

Tollens, Tim; Speybrouck, Sabrina; Devroe, Kurt; Terry, Catherine; Alevoet, Chris; Divilio, L Thomas; Patel, Bababhai; Vanrykel, Jean-Pierre Vanrykel



Increasing hospitalizations and general practice prescriptions for community-onset staphylococcal disease, England.  


Rates of hospital-acquired staphylococcal infection increased throughout the 1990s; however, information is limited on trends in community-onset staphylococcal disease in the United Kingdom. We used Hospital Episode Statistics to describe trends in hospital admissions for community-onset staphylococcal disease and national general practice data to describe trends in community prescribing for staphylococcal disease. Hospital admission rates for staphyloccocal septicemia, staphylococcal pneumonia, staphylococcal scalded-skin syndrome, and impetigo increased >5-fold. Admission rates increased 3-fold for abscesses and cellulitis and 1.5-fold for bone and joint infections. In primary care settings during 1991-2006, floxacillin prescriptions increased 1.8-fold and fusidic acidprescriptions 2.5-fold. The increases were not matched by increases in admission rates for control conditions. We identified a previously undescribed but major increase in pathogenic community-onset staphylococcal disease over the past 15 years. These trends are of concern given the international emergence of invasive community-onset staphylococcal infections. PMID:18439352

Hayward, Andrew; Knott, Felicity; Petersen, Irene; Livermore, David M; Duckworth, Georgia; Islam, Amir; Johnson, Anne M



Characterization of transcription within sdr region of Staphylococcus aureus.  


Staphylococcus aureus is an opportunistic pathogen responsible for various infections in humans and animals. It causes localized and systemic infections, such as abscesses, impetigo, cellulitis, sepsis, endocarditis, bone infections, and meningitis. S. aureus virulence factors responsible for the initial contact with host cells (MSCRAMMs-microbial surface components recognizing adhesive matrix molecules) include three Sdr proteins. The presence of particular sdr genes is correlated with putative tissue specificity. The transcriptional organization of the sdr region remains unclear. We tested expression of the sdrC, sdrD, or sdrE genes in various in vitro conditions, as well as after contact with human blood. In this work, we present data suggesting a separation of the sdr region into three transcriptional units, based on their differential reactions to the environment. Differential reaction of the sdrD transcript to environmental conditions and blood suggests dissimilar functions of the sdr genes. SdrE has been previously proposed to play role in bone infections, whilst our results can indicate that sdrD plays a role in the interactions between the pathogen and human immune system, serum or specifically reacts to nutrients/other factors present in human blood. PMID:20571861

Sitkiewicz, Izabela; Babiak, Ireneusz; Hryniewicz, Waleria



The treatment of diabetic foot infections: focus on ertapenem  

PubMed Central

Clinically, 3 distinct stages of diabetic foot infection may be recognized: localized infection, spreading infection and severe infection. Each of these presentations may be complicated by osteomyelitis. Infection can be caused by Gram-positive aerobic, and Gram-negative aerobic and anaerobic bacteria, singly or in combination. The underlying principles are to diagnose infection, culture the bacteria responsible and treat aggressively with antibiotic therapy. Localized infections with limited cellulitis can generally be treated with oral antibiotics on an outpatient basis. Spreading infection should be treated with systemic antibiotics. Severe deep infections need urgent admission to hospital for wide-spectrum intravenous antibiotics. Clinical and microbiological response rates have been similar in trials of various antibiotics and no single agent or combination has emerged as most effective. Recently, clinical and microbiological outcomes for patients treated with ertapenem were equivalent to those for patients treated with piperacillin/tazobactam. It is also important to judge the need for debridement and surgery, to assess the arterial supply to the foot and consider revascularization either by angioplasty or bypass if the foot is ischemic. It is also important to achieve metabolic control. Thus infection in the diabetic foot needs full multidisciplinary treatment.

Edmonds, Michael



Alpha-1 antitrypsin deficiency in a patient with widespread prurigo nodularis.  


Skin lesions associated with alpha 1-antitrypsin deficiency are becoming better defined and understood. Deficiency in this major antiproteinase, which neutralizes multiple proteolytic enzymes ranging from collagenases and elastases to trypsin and chymotrypsin, thus results in significant tissue autodigestion. This anti-proteinase is secreted by activated lymphocytes and macrophages, suggesting the existence of homeostasis which titrates the release of proteolytic enzymes by these cells, and the adequate neutralization of these proteases in order to prevent excessive tissue autodigestion each time these inflammatory cells are activated. We report a patient with alpha 1-antitrypsin deficiency who, following insect bites and cellulitis developed widespread itching and scratching, leading to widespread lesions of prurigo nodularis. The colonization of his multiple skin lesions with Staphylococcus aureus and the release of potent T cell mitogens, such as Protein A and enterotoxin A from the bacterial cell membrane may have resulted in the release of additional proteolytic enzymes by the activated lymphocytes and macrophages, without the concomitant secretion of alpha 1-antitrypsin with subsequent aggravation of his pruritus. These concepts are supported by electron microscopic evidence of excessive tissue autodigestion, and by immunocytochemical data identifying the presence of T helper and T cytotoxic/suppressor lymphocytes as well as macrophages within the upper dermis. PMID:1823111

Heng, M C; Allen, S G; Kim, A; Lieberman, J



Endodontic diagnosis. Mystery or mastery?  


Review of 6 clinical distinctions: (1) Symptom: "anything under the sun." Diagnosis: pulp exposure. Duplicate: clinical or radiographic pulp exposure evidence. Treatment: endodontics or pulp cap under strict protocol conditions. (2) Symptom: "cold." Diagnosis: hyperemia. Duplicate: ice. Treatment: pulp protection or endodontics. (3) Symptom: "heat." Diagnosis: pulpitis. Duplicate: heat. Treatment: pulpotomy for multirooted teeth or pulpectomy for single-rooted teeth. Schedule endodontic completion. (4) Symptom: "I recently had a toothache and now it is gone." Diagnosis: necrosis. Duplicate: Electric Pulp Test and ice are negative. Treatment: endodontics. (5) Symptom: "I had a toothache awhile back and now it is gone." Diagnosis: LEO. Duplicate: Electric Pulp Test, ice, and test cavity are negative. Treatment: endodontics. (6) Symptom: "It really hurts to touch my tooth." Diagnosis: percussion. Duplicate: may or may not have a LEO and may or may not have cellulitis. Treatment: reduce occlusion, access cavity, water chew, and schedule to finish endodontics. If these tests are carefully performed, then they are objective and the doctor does not have to be in a subjective situation. A newfound sense of endodontic diagnostic mastery is experienced. Perhaps the best way to summarize the simplicity of this clinical diagnostic scheme is to quote Sherlock Holmes: "Nothing is more deceptive than the obvious." PMID:15164479

West, John D



Chronic interdigital dermatophytic infection: a common lesion associated with potentially severe consequences.  


Interdigital intertrigo and onychomycosis has the potential cause of severe bacterial infectious complications with pain, mobility problems, abscess, erysipelas, cellulitis, fasciitis and osteomyelitis. In another hand, diabetic neuropathy, which affects 60-70% of those with diabetes mellitus, is one of the most troubling complications for persons with diabetes. These people are high suspecting to be infected by dermatophytic infections in interdigital spaces or onychomycosis witch are frequently induce damage to the stratum corneum, leading to bacterial proliferation and secondary infection. A patient presented with an asymptomatic warm, painless, erythematous swelling of the second left toe, which had been present for a few weeks. Clinically, the lesion was categorized as erysipelas upon an insidious abscess formation. Further investigation was undertaken to confirm the presence of diabetes. Leg erysipelas is a common affection which, according to various studies, has both local concomitants (interdigital intertrigo, lymphoedema, surgical antecedents) and/or general causes (immune suppression, diabetes, alcoholism, etc). Interdigital intertrigo, tinea pedis, and onychomycosis present as public health problems that could trigger serious deterioration in patient quality of life, due to complications induced by secondary bacterial infections. PMID:21035887

Vanhooteghem, Olivier; Szepetiuk, Gregory; Paurobally, Dilshad; Heureux, Françoise



Role of computed tomography in the assessment of intraorbital foreign bodies.  


Intraorbital foreign bodies (IOFBs) are a common occurrence worldwide and happen at a frequency of once in every 6 cases of orbital trauma. An orbital foreign body may produce a variety of signs and symptoms related to its size, composition, and ballistics. Retained foreign bodies may give rise to cellulitis, abscess, fistulas, and impaired vision and motility. Prompt detection and accurate localization of IOFBs are essential for the optimum management of patients, to enable the surgeon to plan the most atraumatic method of removing the IOFB. Computed tomography (CT) is very useful in determining the size of foreign bodies and localizing them as intraocular, extraocular, or retro-ocular. CT is generally considered the gold standard in the evaluation of IOFBs because it is safe to use with metallic IOFBs, excludes orbitocranial extension, and is also able to diagnose orbital wall fractures and orbital sepsis with high accuracy. Other potential complications excludible by CT are abscess formation in the orbit, bone, and brain. Magnetic resonance imaging is generally not recommended for the evaluation of the foreign bodies because of risks associated with magnetic metal. PMID:22964405

Pinto, Antonio; Brunese, Luca; Daniele, Stefania; Faggian, Angela; Guarnieri, Gianluigi; Muto, Mario; Romano, Luigia



Halo immobilization in the treatment of burns to the head, face, and neck.  


The care of burns to the head, face, and neck remains a challenge to the clinician. From 1978 to 1986, halo traction was used as an immobilizing device and as a protective frame for 31 patients with burns to the head (n = 8), face (n = 24), and neck (n = 28). The patients ranged in age from 8 months to 80 years (mean = 16 years) and had second- and third-degree burns covering a total body surface area of 8% to 75% (mean = 28%). The halo was used for an average of eight days (range one to 19 days) and served to immobilize and protect areas of fresh skin grafts, as well as to elevate and protect scalp donor sites (n = 10). Traction was initially used in patients who were confused and uncooperative, and in patients whose burns involved the neck to provide extension for prophylaxis against contractures. Treatment side effects included intermittent headache and backache, the latter occurring especially in the patients subjected to hyperextension. Eight patients (26%) complained of discomfort, which was reduced with adequate analgesia, sedation, and emotional support. The halo had to be removed from one patient after one day because of a loose pin, and in another patient after eight days because of the development of cellulitis at a pin site. Halo immobilization was used successfully to minimize graft loss in 30 of 31 patients. PMID:3283135

Schubert, W; Kuehn, C; Moudry, B; Miyamoto, S; Ahrenholz, D H; Solem, L D


On-chip cellomics assay enabling algebraic and geometric understanding of epigenetic information in cellular networks of living systems. 1. Temporal aspects of epigenetic information in bacteria.  


A series of studies aimed at developing methods and systems of analyzing epigenetic information in cells and in cell networks, as well as that of genetic information, was examined to expand our understanding of how living systems are determined. Because cells are minimum units reflecting epigenetic information, which is considered to map the history of a parallel-processing recurrent network of biochemical reactions, their behaviors cannot be explained by considering only conventional DNA information-processing events. The role of epigenetic information on cells, which complements their genetic information, was inferred by comparing predictions from genetic information with cell behaviour observed under conditions chosen to reveal adaptation processes, population effects and community effects. A system of analyzing epigenetic information was developed starting from the twin complementary viewpoints of cell regulation as an "algebraic" system (emphasis on temporal aspects) and as a "geometric" system (emphasis on spatial aspects). Exploiting the combination of latest microfabrication technology and measurement technologies, which we call on-chip cellomics assay, we can control and re-construct the environments and interaction of cells from "algebraic" and "geometric" viewpoints. In this review, temporal viewpoint of epigenetic information, a part of the series of single-cell-based "algebraic" and "geometric" studies of celluler systems in our research groups, are summerized and reported. The knowlege acquired from this study may lead to the use of cells that fully control practical applications like cell-based drug screening and the regeneration of organs. PMID:22969343

Yasuda, Kenji



Lower-extremity soft tissue infections with intra-abdominal sources.  


This article describes a series of 3 patients who presented with lower-extremity soft tissue infections. Each patient was treated with prompt debridement by an orthopedic surgeon (J.F.G.) and required at least 1 additional procedure by another surgeon.These infections vary from superficial cellulitis to rapidly advancing necrotizing fasciitis. At times, the source of these infections is clear. Other times, no obvious source of infection exists, in which case the abdomen must be considered as a possible source of infection. A high level of suspicion, complete history and physical examination, and appropriate ancillary studies are required to make an accurate and prompt diagnosis. Options for the treatment of the intra-abdominal source of infection depend on the etiology of the infection and anatomic location of the process. Psoas abscesses can often be decompressed by an interventional radiologist using computed tomography guidance. In the case of bowel involvement, such as suspected carcinoma or diverticulitis, a general surgeon is necessary. When the appropriate diagnosis is made, soft tissue infections of the thigh often respond to appropriate surgical debridement and antibiotic therapy. It is important to remember the whole patient when evaluating soft tissue infections, especially in the thigh. A low threshold for imaging of the abdomen and pelvis is important, especially when the physical examination or medical history reveals the abdomen as a possible source of infection. PMID:22495869

Harrison, Ryan K; Wilmoth, Jill C; Griesser, Michael J; Granger, Jeffrey F



A Case of Helicobacter cinaedi Bacteremia in an Asplenic Patient  

PubMed Central

Helicobacter cinaedi is an enterohepatic species. It can cause bacteremia, gastroenteritis, and cellulitis, particularly in immunocompromised individuals, such as those with acquired immunodeficiency syndrome, malignancy, or alcoholism. There are no previous reports of H. cinaedi infection in Korea. A 71-yr-old man was admitted to the emergency room because of dyspnea on November 9, 2011. He had undergone splenectomy 3 yr ago because of immune hemolytic anemia. Chest plain radiography revealed bilateral pleural effusion. He developed fever on hospital day (HD) 21. Three sets of blood cultures were taken, and gram-negative spiral bacilli were detected in all aerobic vials. The isolate grew in tiny colonies on chocolate agar after 3-day incubation under microaerophilic conditions. This organism tested positive for catalase and oxidase, and negative for urease. The 16S rRNA gene sequence of this isolate exhibited 99.8% homology with the published sequence of H. cinaedi CCUG 18818T (GenBank accession no. ABQT01000054) and 98.5% homology with the sequence of Helicobacter bilis Hb1T (GenBank accession no. U18766). The patient was empirically treated with piperacillin/tazobactam and levofloxacin, and discharged with improvement on HD 31. To our knowledge, this is the first report of H. cinaedi bacteremia in an asplenic patient. Asplenia appears to be a risk factor for H. cinaedi bacteremia.

Kim, Soo-Kyung; Cho, Eun-Jung; Sung, Heungsup; An, Dongheui; Park, Sook-Ja; Nam, Gi-Byoung



Evaluation and management of pain in patients with Klippel-Trenaunay syndrome: a review.  


Klippel-Trenaunay syndrome (KTS) is a rare disorder that consists of a triad of capillary vascular malformation, venous malformations and/or varicose veins, and soft tissue and/or bony hypertrophy. Pain is a real and debilitating problem in these patients. We have observed 9 common causes of pain in KTS: (1) chronic venous insufficiency, (2) cellulitis, (3) superficial thrombophlebitis, (4) deep vein thrombosis, (5) calcification of vascular malformations, (6) growing pains, (7) intraosseous vascular malformation, (8) arthritis, and (9) neuropathic pain. The management of pain in patients with KTS depends on its cause. These patients are best evaluated initially in a center with an experienced multidisciplinary team that includes a primary health care provider, surgeons, and ancillary staff. The ongoing care of a patient with KTS often depends on a local provider who is more readily accessible to the patient but may not have the expertise of a large center to manage the complications of KTS. The purpose of this communication is to review the common causes of pain in these patients to provide local health care providers and patients and their families with appropriate management strategies. PMID:15741381

Lee, Adriana; Driscoll, David; Gloviczki, Peter; Clay, Ricky; Shaughnessy, William; Stans, Anthony



Inadvertent Evisceration of Eyes Containing Uveal Melanoma  

PubMed Central

Objectives To report an important complication of ocular evisceration therapy for blind, painful eyes that has been unreported in the literature, and to stress the need for careful preoperative evaluation to exclude occult neoplasms prior to therapy. Design Multicenter, retrospective, nonrandomized clinicopathological case series of patients found to have previously unsuspected uveal malignant melanoma during histopathological examination of blind, painful eyes treated by evisceration. Results Histopathological examination of evisceration specimens disclosed previously unsuspected uveal melanoma in 7 patients who were treated for blind, painful eyes. Inflammation caused by necrosis of the tumor and other ocular tissues led to misdiagnosis as endophthalmitis, orbital cellulitis, or idiopathic orbital inflammation in several cases. Preoperative imaging was not performed in 3 cases and failed to detect tumors in the remaining 4 cases. Failure of necrotic tumors to enhance contributed to misdiagnosis. Conclusions The presence of a malignant intraocular neoplasm should be excluded prior to evisceration of any blind eye or blind, painful eye, particularly with opaque media. Necrosis-related inflammation can confound the clinical diagnosis of occult lesions, as can failure of necrotic tumors to enhance on imaging studies.

Eagle, Ralph C.; Grossniklaus, Hans E.; Syed, Nasreen; Hogan, R. Nick; Lloyd, William C.; Folberg, Robert



Diagnosis and treatment of venous ulcers.  


Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. Possible causes of venous ulcers include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. On physical examination, venous ulcers are generally irregular, shallow, and located over bony prominences. Granulation tissue and fibrin are typically present in the ulcer base. Associated findings include lower extremity varicosities, edema, venous dermatitis, and lipodermatosclerosis. Venous ulcers are usually recurrent, and an open ulcer can persist for weeks to many years. Severe complications include cellulitis, osteomyelitis, and malignant change. Poor prognostic factors include large ulcer size and prolonged duration. Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures. PMID:20387775

Collins, Lauren; Seraj, Samina



Modélisation d'un transformateur à shunts magnétiques utilisé dans l'alimentation H.T. d'un générateur micro-ondes à magnétron  

NASA Astrophysics Data System (ADS)

The high voltage power supply for magnetron, used for the modular microwave generators in industrial applications, is of a classical design : a single phase leakage flux transformer supplying a cell, composed of a capacitor and a diode, which multiplies the voltage and stabilizes the current. A ? model of this transformer is developed, taking the saturation phenomena and the stabilization process of the magnetron current into account. Three inductances are characterized by the non linear relations between flux and magnetizing current. This model was tested by E.M.T.P. software (Electro-Magnetic Transients Program), near the nominal state. The theoretical results were compared to experimental measurements with a good agreement. L'alimentation haute tension des magnétrons, utilisés comme source d'énergie microondes dans l'industrie, est de conception classique : un transformateur monophasé à fuites magnétiques alimentant une cellule doubleuse de tension et stabilisatrice de courant. Un schéma équivalent en ? du transformateur est présenté, prenant en compte la saturation des différentes parties du fer et la stabilisation du courant du magnétron. Trois inductances sont caractérisées par les relations non linéaires entre flux et courant magnétisant. Ce modèle a été testé à l'aide du logiciel de calcul E.M.T.P. (Electro-Magnetic Transients Program), au voisinage du régime nominal. Les résultats théoriques, comparés aux mesures expérimentales, se trouvent en bon accord avec elles.

Chraygane, Mohamed; Teissier, Maurice; Jammal, Ahmad; Masson, Jean-Pierre



On-Chip Cellomics Assay Enabling Algebraic and Geometric Understanding of Epigenetic Information in Cellular Networks of Living Systems. 1. Temporal Aspects of Epigenetic Information in Bacteria  

PubMed Central

A series of studies aimed at developing methods and systems of analyzing epigenetic information in cells and in cell networks, as well as that of genetic information, was examined to expand our understanding of how living systems are determined. Because cells are minimum units reflecting epigenetic information, which is considered to map the history of a parallel-processing recurrent network of biochemical reactions, their behaviors cannot be explained by considering only conventional DNA information-processing events. The role of epigenetic information on cells, which complements their genetic information, was inferred by comparing predictions from genetic information with cell behaviour observed under conditions chosen to reveal adaptation processes, population effects and community effects. A system of analyzing epigenetic information was developed starting from the twin complementary viewpoints of cell regulation as an “algebraic” system (emphasis on temporal aspects) and as a “geometric” system (emphasis on spatial aspects). Exploiting the combination of latest microfabrication technology and measurement technologies, which we call on-chip cellomics assay, we can control and re-construct the environments and interaction of cells from “algebraic” and “geometric” viewpoints. In this review, temporal viewpoint of epigenetic information, a part of the series of single-cell-based “algebraic” and “geometric” studies of celluler systems in our research groups, are summerized and reported. The knowlege acquired from this study may lead to the use of cells that fully control practical applications like cell-based drug screening and the regeneration of organs.

Yasuda, Kenji



Diverse Presentations of Carcinoma Erysipelatoides from a Teaching Hospital in Australia  

PubMed Central

Inflammatory breast carcinoma is a rare form of advanced breast cancer which carries a poor prognosis, even with treatment. Diagnosis is reached on clinical and pathological grounds; however, due to its propensity to mimic other conditions, it may often be delayed or missed by attending physicians. This case series describes four patients seen at our institution with a diagnosis of inflammatory breast cancer; 3 patients had a history of previously treated breast malignancy. In these cases, the emergence of a new breast lesion evaded initial diagnosis due to incomplete initial physical examination, falsely reassuring imaging results, lack of recognition that a cellulitis picture can resemble metastatic carcinoma, and inconclusive initial biopsy sections. These obstacles to achieve diagnosis serve to further worsen the prognosis by delaying the initiation of multimodality treatment which can improve survival. The purpose of our paper is to increase awareness among breast cancer specialists of the importance of undressing the patient for basic clinical examination of the breasts, recognition of the appearances of this type of local recurrence of breast cancer, and not to rely purely on ultrasound and mammography due to delay in diagnosis in some of our local cases. Sometimes deeper sections and repeat biopsies are needed to make the diagnosis.

Chow, Hui Ting; Tran, Kim; Millar, Ewan K. A.; Lynch, Jodi; Murrell, Dedee F.



Skin and Soft Tissue Infections in Patients with Solid Tumours  

PubMed Central

Background. Skin and soft tissue infections (SSTIs) in cancer patients represent a diagnostic challenge, as etiologic diagnosis is often missing, and clinical assessment of severity is difficult. Few studies have described (SSTIs) in patients with solid tumours (STs). Patients and Methods. Records of patients with ST and SSTI, cared for at the University Hospital of Heraklion, from 2002 to 2006 were retrospectively studied. Results. A total of 81 episodes of SSTIs, occurring in 71 patients with ST, have been evaluated. Their median age was 65 years (34–82). The most common underlying malignancy was breast cancer in 17 patients (24%). Most episodes (89%) occurred in nonneutropenics. Cellulitis/erysipelas was the most common clinical presentation (56; 69%). Bacterial cultures were possible in 29 (36%) patients. All patients received antimicrobial therapy, while in 17 episodes (21%) an incision and drainage was required. Treatment failure occurred in 20 episodes (25%). Five patients (7%) died due to sepsis. None was neutropenic. Severe sepsis on admission (P = 0.002) and prior blood transfusion (P = 0.043) were independent predictors of treatment failure. Conclusion. SSTIs can be life threatening among patients with ST. Early diagnosis and appropriate treatment are of the utmost importance, since sepsis was proven a significant factor of unfavourable outcome.

Kofteridis, Diamantis P.; Valachis, Antonios; Koutsounaki, Eirini; Maraki, Sofia; Mavrogeni, Eleni; Economidou, Foteini N.; Dimopoulou, Dimitra; Kalbakis, Kostas; Georgoulias, Vassilis; Samonis, George



Characteristics and clinical presentations of pediatric retinoblastoma in North-western Iran  

PubMed Central

AIM To report the characteristics and clinical presentations of retinoblastoma in a series of pediatric patients from Iran. METHODS In this retrospective study, profiles of pediatric patients with retinoblastoma archived in a referral eye hospital in north-west of Iran during 7 years (n=40 patients with 57 eyes) were reviewed. Demographics, as well as the laterality, clinical manifestations and the types of treatment were the major endpoints. The Student's t test, Mann-Whitney U-test, Chi-square or Fishers' Exact test was used for analysis where appropriate. RESULTS There were 23 cases (57.7%) with unilateral and 17 cases (42.5%) with bilateral involvement. The male to female ratio was 1 to 1.4 with a mean admitting age of 24.0±11.3 (range: 5-62) months. The mean diagnosis delay was 7.4±9.6 months (range: 10 days to 13 months). The most common presenting sign was leukocoria (97.5%) followed by proptosis (7.5%), strabismus (7.5%), hyphema (5%), orbital cellulitis (5%) and glaucoma (2.5%). Enucleation was performed in 95.7% of the cases with unilateral involvement and at least one eye of the patients with bilateral disease. A second enucleation was performed in other 3 patients (17.6%) of the latter group. CONCLUSION This is the first study evaluating a series of Iranian children with retinoblastoma.

Nabie, Reza; Taheri, Nazli; Fard, Ali Mahdavi; Fouladi, Rohollah Fadaei



Diagnosis and Percutaneous Treatment of Soft-Tissue Hydatid Cysts  

SciTech Connect

The purpose of this study is to demonstrate and discuss the radiological features of four patients with muscular hydatid disease and to evaluate the results of percutaneous treatment in these patients. Four patients (three female and one male) with six muscular hydatid cysts underwent percutaneous treatment and were followed up. The mean age of patients was 35 years (range: 12-60 years). Type I (n = 2), type II (n = 1), and type III (n = 3) hydatid cysts were observed in the thigh (n = 3) and gluteal (n = 1) region on radiologic examination. All interventions were performed under sonographic and fluoroscopic guidance. According to the type of the cyst, the procedure was carried out by either a 'catheterization technique with hypertonic saline and alcohol' or a 'modified catheterization technique.' The mean cathaterization time was 13.7 days, ranging from 1 to 54 days. The dimensions of the residual cavity were noted at every sonographic control, and an average of 96.1% volume reduction was obtained in six cysts of four patients. No sign of viability was observed during the follow-up period. Cavity infection and cellulitis were observed as complications, which resolved after medical therapy. Percutaneous treatment is a safe and effective procedure in patients with soft-tissue hydatid cysts and should be considered as a serious alternative to surgery.

Akhan, Okan [Bayindir Hospital, Sogutozu, Department of Radiology (Turkey)], E-mail:; Gumus, Burcak; Akinci, Devrim; Karcaaltincaba, Musturay; Ozmen, Mustafa [Hacettepe University School of Medicine, Department of Radiology (Turkey)



Management of simple insect bites: where's the evidence?  


Many insects bite in order to obtain a blood meal and, in the process, inject the victim with saliva that may contain a number of substances, some of which can be immunogenic. The consequences of insect bites include local reactions, immune (allergic) reactions including anaphylaxis, and secondary bacterial infections (e.g. impetigo, cellulitis). Although insect bites are perceived to be common in the UK, the exact incidence is difficult to estimate since most are likely to go unreported: only those causing the more serious reactions are seen in primary care settings. Simple insect bites are those that are not accompanied or followed by anaphylactic shock or systemic infection. Many preparations for the treatment of insect bites, including antihistamines and topical corticosteroids, are available for purchase over the counter (OTC) in the UK. However, there is a lack of evidence for the efficacy of these treatments and, in general, recommendations for treatment are based on expert opinion and clinical experience. This article reviews the evidence for the management of simple bites by insects commonly encountered in the UK, but excludes ticks, mites and lice. PMID:22495051



Granulomatous pneumonia caused by Pythium insidiosum in a central American jaguar, Panthera onca.  


A 7-month-old, male jaguar presented with dyspnea and leukocytosis unresponsive to antibiotic therapy. Radiographs revealed unilateral pulmonary consolidation. An exploratory thoracotomy was performed, and the left lung, which contained a large multilobular mass with extensive fibrosis and numerous caseonecrotic foci, was removed. Microscopically, eosinophilic granulomatous inflammation surrounded broad (4.4-8.3 microm) rarely septate hyphae. A diagnosis of Pythium insidiosum infection was confirmed by immunohistochemistry, immunoblot serology, culture, and polymerase chain reaction. Dyspnea recurred despite treatment, and the animal succumbed 3 weeks after surgery. Necropsy findings indicated that death resulted from occlusion of the right main stem bronchus by a fungal granuloma. The oomycete P. insidiosum typically causes granulomatous disease of the skin or gastrointestinal tract in animals and arteritis, keratitis, or cellulitis in humans. Infection is uncommon in felines, and pulmonary involvement is rare. This report details the first case of P. insidiosum infection in an exotic felid and provides the first description of primary pulmonary pythiosis in any species. PMID:15586573

Camus, Alvin C; Grooters, Amy M; Aquilar, Roberto E



Outpatient parenteral antibiotic therapy: principles and practice.  


Outpatient parenteral antimicrobial therapy (OPAT) refers to the administration of a parenteral antimicrobial in a non inpatient or ambulatory setting with the explicit aim of facilitating admission avoidance or early discharge. Whilst OPAT has predominantly been the domain of the infection specialist, the internal medicine specialist has a key role in service development and delivery as a component of broader ambulatory care initiatives such as "hospital at home". Main drivers for OPAT are patient welfare, reduction of risk of health care associated infection and cost-effective use of hospital resources. The safe practice of OPAT is dependent on a team approach with careful patient selection and antimicrobial management with programmed and adaptable clinical monitoring and assessment of outcome. Gram-positive infections, including cellulitis, bone and joint infection, bacteraemia and endocarditis are key infections potentially amenable to OPAT whilst resistant Gram-negative infections are of increasing importance. Ceftriaxone, teicoplanin, daptomycin and ertapenem lend themselves well to OPAT due to daily (or less frequent) bolus administration, although any antimicrobial may be administered if the patient is trained to administer and/or an appropriate infusion device is employed. Clinical experience from NHS Greater Glasgow and Clyde is presented to illustrate the key principles of OPAT as practised in the UK. Increasingly complex patients with multiple medical needs, the relative scarcity of inpatient resources and the broader challenge of ambulatory care and "hospital at home" will ensure the internal medicine specialist will have a key role in the future development of OPAT. PMID:23602223

Seaton, R A; Barr, D A



Instabilité électrohydrodynamique due à l'injection d'ions à la surface libre d'un liquide isolant  

NASA Astrophysics Data System (ADS)

We study experimentally the electrohydrodynamic instability of a plane layer of insulating liquid subjected to ion injection when one boundary is rigid and the other one is the free surface of the liquid (ion injection into the liquid is produced by a corona discharge in air). Linear and non-linear instability criteria are obtained and compared to existing theories. Visual observations evidence the convective structure (in the form of hexagonal cells) which, in some conditions, is restricted to only part of the layer subjected to the injection. Nous présentons une étude expérimentale de l'instabilité électrohydrodynamique d'une couche plane de liquide isolant soumise à une injection d'ions sur la surface libre (ions produits par une décharge couronne dans l'air). Les critères linéaire et non linéaire d'instabilité sont déterminés et comparés aux théories existantes. La visualisation du mouvement met en évidence une structure convective sous forme de cellules hexagonales qui, dans certaines conditions, est restreinte à une partie seulement de la couche liquide soumise à l'injection.

Malraison, B.; Atten, P.



Méthodologie d'approche pour la conception des transistors VDMOS de puissance  

NASA Astrophysics Data System (ADS)

In this paper, a design method for Power MOSFET devices, based on the physical phenomena and electrical properties of the structure, is presented. This method is implemented in a software called Power MOSFET's Designer, which only needs three inputs : the layout (cells, design rules, chip area), the breakdown voltage and the technological family characteristics, to define the SPICE equivalent circuit of the transistor. It is well suited to the simulation of power electronics circuits. Application examples are given. Cette communication présente une approche de conception de transistor MOS de puissance basée sur les propriétés physiques et électriques du dispositif. On propose à partir i) de la géométrie (dimensionnement des cellules, règles de dessin, taille de puce), ii) de la tenue en tension et iii) du processus technologique, de déterminer a priori les performances électriques du composant. Cette approche passe par la topologie d'un schéma équivalent éprouvé et aboutit à des caractéristiques électriques statiques et en commutation dans des circuits typiques de l'électronique de puissance. Des exemples d'application sont proposés.

Beydoun, B.; Tranduc, H.; Oms, F.; Peyre Lavigne, A.; Rossel, P.



Contribution à la modélisation des convertisseurs statiques pour la simulation à topologie variable  

NASA Astrophysics Data System (ADS)

This paper presents a simple and structured method of static converter modelling with variable topology, for the simulation of controlled converter-machine drives. The methodology is based on the notion of switching cells which enables a modular decomposition of converters in structures easy to be studied and henceforth called independent converter legs. These independent legs will be stored in libraries (algorithms or programs, and models) in order to be re-used for the study of other converters. Cet article propose une méthode simple et structurée pour la modélisation des convertisseurs statiques par des modèles à topologie variable, en vue de la simulation d'associations machine-convertisseur-commande complètes. Cette démarche s'appuie sur la notion de cellule de commutation pour permettre de dégager une décomposition modulaire du convertisseur en structures élémentaires, faciles à étudier, qui seront appelées bras indépendants. Ces derniers sont stockés en bibliothèque (sous forme d'algorithme ou programme, et sous forme de modèle), pour être réutilisés dans l'étude d'autres convertisseurs.

Sahraoui, Omar; Gerbaud, Laurent; Normand, Olivier; Roudet, James



Anaerobic infections in children.  


Anaerobic bacteria commonly cause infection in children. Anaerobes are the most predominant components of the normal human skin and mucous membranes bacterial flora and are therefore a common cause of bacterial infections of endogenous origin. Because of their fastidious nature, they are difficult to isolate from infectious sites and are often overlooked. Anaerobic infections can occur in all body sites, including the central nervous system, oral cavity, head and neck, chest, abdomen, pelvis, skin, and soft tissues. They colonize the newborn after delivery and have been recovered from several types of neonatal infections. These include cellulitis of the site of fetal monitoring, neonatal aspiration pneumonia, bacteremia, conjunctivitis, omphalitis, and infant botulism. The failure to direct adequate therapy against these organisms may lead to clinical failures. Their isolation requires appropriate methods of collection, transportation, and cultivation of specimens. Treatment of anaerobic infection is complicated by the slow growth of these organisms, by their polymicrobial nature, and by the growing resistance of anaerobic bacteria to antimicrobials. Antimicrobial therapy is often the only form of therapy required, whereas in others it is an important adjunct to a surgical approach. Because anaerobic bacteria generally are recovered mixed with aerobic organisms, the choice of appropriate antimicrobial agents should provide for adequate coverage of both types of pathogen. PMID:21120724

Brook, Itzhak



Infected facial tissue fillers: case series and review of the literature.  


Since 2007, 21 female and 1 male patient aged 25 to 55 years, who either did not have any obvious causative infection source or, despite the presence of nonvital teeth, did not display typical symptoms of odontogenic infection, were treated for acute facial inflammation. All these patients admitted previous application of injectable soft tissue fillers (ISTFs) performed in either private plastic surgery and dermatology practices or cosmetic salons. The period between injection and infection varied from 1 week to 6 years. The injected substance remained unknown in many cases. Of the 22 patients, 3 were diagnosed with facial cellulitis, 4 with periorbital abscess, and 15 with a buccal space abscess. ISTFs provide an attractive option in facial rejuvenation. With their increasing use, the prevalence of complications is also expected to increase. Infectious complications of ISTFs were previously unknown in Kuwait. Although these products are primarily meant for treatment of the aging face, the age pattern of our patients suggests their frequent misuse and spurious indications. Especially worrisome is the recently observed application of fillers in cosmetic salons. We believe that the use of ISTFs should be regulated and their administration in nonmedical facilities prohibited. Patients with an atypical course of facial inflammation should be questioned about a history of cosmetic procedures. PMID:22342250

Schütz, Petr; Ibrahim, Hussein Hassan Hamed; Hussain, Sabreyah Saleh; Ali, Tamer Sabry; El-Bassuoni, Khalid; Thomas, John



Management of Bartholin's duct cyst and gland abscess.  


Bartholin's duct cysts and gland abscesses are common problems in women of reproductive age. Bartholin's glands are located bilaterally at the posterior introitus and drain through ducts that empty into the vestibule at approximately the 4 o'clock and 8 o'clock positions. These normally pea-sized glands are palpable only if the duct becomes cystic or a gland abscess develops. The differential diagnosis includes cystic and solid lesions of the vulva, such as epidermal inclusion cyst, Skene's duct cyst, hidradenoma papilliferum, and lipoma. The goal of management is to preserve the gland and its function if possible. Office-based procedures include insertion of a Word catheter for a duct cyst or gland abscess, and marsupialization of a cyst; marsupialization should not be used to treat a gland abscess. Broad-spectrum antibiotic therapy is warranted only when cellulitis is present. Excisional biopsy is reserved for use in ruling out adenocarcinoma in menopausal or perimenopausal women with an irregular, nodular Bartholin's gland mass. PMID:12887119

Omole, Folashade; Simmons, Barbara J; Hacker, Yolanda



Clinafloxacin versus Piperacillin-Tazobactam in Treatment of Patients with Severe Skin and Soft Tissue Infections  

PubMed Central

Patients (n = 409) with severe skin and soft tissue infections (SSTIs) were randomized to receive clinafloxacin or piperacillin-tazobactam (plus optional vancomycin for methicillin-resistant cocci), administered intravenously, with the option to switch to oral medication. Most patients had cellulitis, wound infections, or diabetic foot infections. Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa were the most common baseline pathogens. Fewer baseline pathogens were resistant to clinafloxacin (1.8%) than to piperacillin-tazobactam (6.2%) (P = 0.001). The clinafloxacin and piperacillin-tazobactam groups did not differ significantly in clinical cure rates (68.8 and 65.2%, respectively) or microbiologic eradication rates (61.5 and 57.2%). Clinafloxacin yielded higher eradication rates for all three of the most common pathogenic species, although no differences were statistically significant. Within the power of this study, the overall frequency of adverse events was similar (P = 0.577) in the two treatment groups. Drug-associated adverse events (P = 0.050) and treatment discontinuations (P = 0.052) were marginally more frequent in the clinafloxacin group, primarily due to phototoxicity in outpatients receiving clinafloxacin. Although most cases of phototoxicity were mild to moderate, four cases were reported as severe. In summary, clinafloxacin monotherapy was equivalent in effectiveness to therapy with piperacillin-tazobactam plus optional vancomycin in the treatment of hospitalized patients with severe SSTIs.

Siami, G.; Christou, N.; Eiseman, I.; Tack, K. J.



A Golgi study on neuronal morphology of the ventral lateral geniculate nucleus of the lizard.  


The architecture and cellular morphology of the ventral geniculate nucleus (vLGN) of Lacerta sicula (Rafinesque) were investigated by means of classical neuroanatomical methods (Bodian, Klüver-Barrera, Cresyl-violet, and rapid Golgi impregnation). The vLGN of L. sicula is located in the laterodorsal portion of the diencephalon throughout the ventral thalamus. It appears sickle-shaped in cross section and contains a) a lateral neuropil, close to the marginal optic tract; b) a medial cell plate and c) an internal neuropil. Golgi preparations show a diffuse population of multipolar, "tufted" and bipolar neurons together with scattered glial cells in the lateral neuropil of vLGN. In the cell plate, two or three rows of cells of medium size, largely corresponding to the so called "cellule a doppio pennacchio" (Beccari, 1923) are found. These cells are endowed with two dendritic trunks, extending respectively into the internal neuropil and toward the optic tract. This latter process shows a quite complex arborization, closely intermingling with the retinal fibres arising from the marginal optic tract. The axons of these cells contribute to the fasciculus geniculatus descendens, the main efferent system of the vLGN. PMID:7130675

Franzoni, M F; Fasolo, A



Visual diagnosis: 2-month-old girl with left eye swelling, profuse tearing.  


Nasolacrimal duct (NLD) obstruction is the most common cause of persistent tearing in a child younger than 1 year. Other possible causes include congenital eyelid abnormalities, chemical irritation, trauma, occult foreign body, congenital or early-onset glaucoma, and conjunctivitis. • In addition to NLD obstruction signs, dacryocystoceles also present with swelling over the nasolacrimal sac. The swelling often has a bluish discoloration. • Management of NLD obstruction requires a conservative approach with observation and nasolacrimal massage because spontaneous resolution occurs in approximately 90% by age 6 months and in more than 99% by age 12 months. Referral to an ophthalmologist for children with persistent symptoms should be deferred until at least ages 6 to 9 months. • Because of the high risk of complications with dacryocystoceles, especially infection, these patients require urgent ophthalmology referral. • Acute dacryocystitis presents with erythema, swelling, warmth, and tenderness of the lacrimal sac. The infection must be identified and treated early to prevent complications, such as periorbital and orbital cellulitis, meningitis, brain abscess, and sepsis. PMID:23908367

O'Connor, Meghan Mary; King, Marta Ania



Systemic CA-MRSA infection following trauma during soccer match in inner Brazil: clinical and molecular characterization.  


Even though community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) was described a decade ago, reports from Brazil are scarce and cases occurred in large urban centers. We report MRSA sepsis in a 16-year-old male from a small town and who had no history of exposure to healthcare or recent travel. After trauma during a soccer match, he presented swelling in the right thigh, which evolved in a month to cellulitis complicated by local abscess, orchitis and pneumonia. The patient presented severe sepsis, with fever and respiratory failure. Laboratory findings included blood leukocyte counts above 40,000/mm(3) and thrombocytopenia. He was submitted to mechanical ventilation and therapy with vancomycin and imipenem. He had a slow but favorable response to therapy and was discharged after six weeks of hospitalization. MRSA grew from blood cultures and respiratory aspirates obtained before antimicrobial therapy. The isolate belonged to sequence type 5, spa type t311, harbored SCCmec type IV and genes for Panton-Valentine leukocidin and Enterotoxin A. The pulsed-field gel electrophoresis pattern was distinct from North American classic CA-MRSA clones. However, the sequence type and the spa type revealed that the clone belong to the same clonal complex isolated in Argentina. This is the first CA-MRSA infection reported in that region, with significant epidemiologic and clinical implications. PMID:23602786

Camargo, Carlos Henrique; da Cunha, Maria de Lourdes Ribeiro de Souza; Bonesso, Mariana Fávero; da Cunha, Fabiana Picoli; Barbosa, Alexandre Naime; Fortaleza, Carlos Magno Castelo Branco



Serious soft tissue infections of the head and neck  

SciTech Connect

The head and neck contain a number of spaces that can be invaded by organisms of the mouth or by spread of cervical osteomyelitis. Infection in these spaces may progress from superficial infection to cellulitis to the formation of an abscess requiring immediate drainage. Spread of infection between spaces depends on anatomic location. Most patients require hospitalization and intravenous antibiotic therapy. Because a deep space infection may be occult, a high index of suspicion is required for diagnosis. Early recognition is necessary to avoid tissue damage, bacteremia or airway compromise. The possibility of deep space infection should be considered in any patient who does not respond to the usual treatment of an abscessed tooth or tonsillitis. This type of infection also should be considered in a toxic patient who has a fever of unknown origin, with or without blood cultures that show anaerobic organisms. Computed tomography or magnetic resonance imaging is usually necessary to locate the infection and to detect suppuration that will be amenable to surgical exploration and drainage. 25 references.

Herr, R.D.; Murdock, R.T.; Davis, R.K. (University of Utah School of Medicine, Salt Lake City (USA))



Noninvasive evaluation of the swollen extremity: Experiences with 190 lymphoscintigraphic examinations  

SciTech Connect

Lymphoscintigraphy (LS), performed with technetium 99m-labeled antimony trisulfide colloid, was used as a noninvasive diagnostic examination to evaluate the lymphatic circulation in 190 extremities of 115 patients. Forty-six patients had primary lymphedema, 48 had secondary lymphedema, and 21 patients had other causes of limb swelling. To determine the value of LS in surgical decision making, preoperative and postoperative LS of 16 patients who underwent surgical repair of the lymphatic abnormality were studied separately. Semiquantitative evaluation of the lymphatic drainage and visual interpretation of the image patterns were reliable to differentiate lymphedema from edemas of other origin (sensitivity: 92%, specificity: 100%). Although certain image patterns were characteristic of either primary or secondary lymphedema, LS could not consistently differentiate between the two types. Episodes of cellulitis in lymphedema clearly delayed lymph transport. LS was helpful in patient selection and follow-up after lymphatic surgery, but it did not prove patency of lymphovenous anastomoses. It was diagnostic in the evaluation of lymphangiectasia and was used to document successful surgical treatment of reflux of chyle. LS is safe and reliable and has no side effects. It should replace contrast lymphangiography in the routine evaluation of the swollen extremity.

Gloviczki, P.; Calcagno, D.; Schirger, A.; Pairolero, P.C.; Cherry, K.J.; Hallett, J.W.; Wahner, H.W.



Axillary sampling in the definitive treatment of breast cancer by radiation therapy and lumpectomy  

SciTech Connect

Between January, 1967 and July, 1980, 176 women who were referred to the Joint Center for Radiation Therapy (JCRT) for definitive breast irradiation underwent low axillary dissection. A typical operative technique is described. The dissection stops short of the axillary vein although the vein is usually visualized. One hundred thirty-two axillae were thought to be N/sub 0/ or N/sub 1a/. Forty-six axillae were felt to be N/sub 1b/. Seventeen percent of the T/sub 1/ N/sub 0/ patients had pathologically positive nodes. Twenty-seven percent of the T/sub 2/ N/sub 0/ patients had positive nodes. When 5 or less nodes were removed at axillary sampling the incidence of nodal involvement was very low. There were no differences in nodal positivity when comparing under quadrant to lower or central lesions. Ninety-four percent of axillae with N/sub 1b/ lesions were pathologically confirmed. The complication rate for this procedure was low. There was 5 transient non-surgical complications and 1 cellulitis resulting in a frozen shoulder, which required corrective surgery. There were no cases of moderate or severe arm edema. Axillary sampling is compared to axillary dissection as a diagnostic procedure. Axillary sampling may underestimate the true pathologic positive rate, but diagnostic accuracy appears excellent if level 1 and 2 nodes are sampled.

Rose, C.M.; Botnick, L.E.; Weinstein, M.; Harris, J.R.; Koufman, C.; Silen, W.; Hellman, S.



Splenic hypofunction in the nephrotic syndrome of childhood  

SciTech Connect

The reticuloendothelial system, including the spleen, subserves important immunologic functions. Loss of splenic function results in an increased incidence of severe bacterial infections and is accompanied by thrombocytosis. Several nephrotic children were noted to have remarkably high platelet counts and predisposition to bacterial infection with encapsulated organisms. We, therefore, investigated the splenic function of nine children with primary nephrotic syndrome and measured the phagocytic function of the spleen by sequestration of Technetium-99-labelled heat-treated autologous RBC, administered intravenously. Four children had decreased splenic function. Repeat studies performed in two of these children after remission of the nephrotic syndrome gave normal results. There were six episodes of bacterial infection (3 peritonitis, 1 septic arthritis, 1 cellulitis, and 1 Escherichia coli urinary tract infection) among the four patients with decreased splenic function. There were no episodes of bacterial infection among the five nephrotic children with normal splenic function. Nephrotic patients with decreased splenic function had significantly increased platelet counts (921,000 +/- 196,000; mean +/- SEM) compared to those with normal function (435,000 +/- 46,000; P less than 0.001). Our findings suggest the possibility that some nephrotic children may have decreased splenic function in association with increased susceptibility to bacterial infections.

McVicar, M.I.; Chandra, M.; Margouleff, D.; Zanzi, I.



Infections acquired in clinical laboratories in Utah.  


We reviewed laboratory-acquired infections occurring in Utah from 1978 through 1982. Written and telephone interviews of supervisors of 1,191 laboratorians revealed an estimated annual incidence of 3 laboratory-acquired infections per 1,000 employees. Infections, in order of frequency, included hepatitis B (clinical cases), shigellosis, pharyngitis, cellulitis, tuberculosis (skin test conversion), conjunctivitis, and non-A, non-B hepatitis. One-half of large laboratories (over 25 employees), but only 12% of smaller laboratories, reported infections. The annual incidence, however, at smaller laboratories was more than three times greater than at large laboratories (5.0 versus 1.5 per 1,000; P less than 0.05, chi-square test). Microbiologists were at greatest risk of infection, with an incidence of almost 1%, followed by generalists and phlebotomists. Shigellosis was acquired only by microbiologists and accounted for more than half of their infections. The most common laboratory-acquired infection, hepatitis B, affected a microbiologist, a hematologist, a phlebotomist, a pulmonary blood gas technician, and a blood bank technologist who died from her illness. Clinical cases of hepatitis B occurred at a rate 10 times higher than the rate in the general U.S. population. The incidence of tuberculosis skin test conversion was intermediate between rates reported for hospital employees and for the state of Utah. PMID:3157700

Jacobson, J T; Orlob, R B; Clayton, J L



Type I Interferon Production Induced by Streptococcus pyogenes-Derived Nucleic Acids Is Required for Host Protection  

PubMed Central

Streptococcus pyogenes is a Gram-positive human pathogen that is recognized by yet unknown pattern recognition receptors (PRRs). Engagement of these receptor molecules during infection with S. pyogenes, a largely extracellular bacterium with limited capacity for intracellular survival, causes innate immune cells to produce inflammatory mediators such as TNF, but also type I interferon (IFN). Here we show that signaling elicited by type I IFNs is required for successful defense of mice against lethal subcutaneous cellulitis caused by S. pyogenes. Type I IFN signaling was accompanied with reduced neutrophil recruitment to the site of infection. Mechanistic analysis revealed that macrophages and conventional dendritic cells (cDCs) employ different signaling pathways leading to IFN-beta production. Macrophages required IRF3, STING, TBK1 and partially MyD88, whereas in cDCs the IFN-beta production was fully dependent on IRF5 and MyD88. Furthermore, IFN-beta production by macrophages was dependent on the endosomal delivery of streptococcal DNA, while in cDCs streptococcal RNA was identified as the IFN-beta inducer. Despite a role of MyD88 in both cell types, the known IFN-inducing TLRs were individually not required for generation of the IFN-beta response. These results demonstrate that the innate immune system employs several strategies to efficiently recognize S. pyogenes, a pathogenic bacterium that succeeded in avoiding recognition by the standard arsenal of TLRs.

Gratz, Nina; Hartweger, Harald; Matt, Ulrich; Kratochvill, Franz; Janos, Marton; Sigel, Stefanie; Drobits, Barbara; Li, Xiao-Dong; Knapp, Sylvia; Kovarik, Pavel



Low-invasive lymphatic surgery and lymphatic imaging for completely healed intractable pudendal lymphorrhea after gynecologic cancer treatment.  


Lower limb lymphedema and an accompanying lymphatic fistula (lymphorrhea) occur as complications after gynecologic surgery to treat cancer. Herein, we report the case of a 68-year-old woman who underwent resection and radiotherapy because of uterine cervical cancer (stage 2a) 20 years previously. Left lower limb and pudendal lymphedema and continuous lymphorrhea developed soon after surgery. Conservative treatment was administered; however, the edema increased, and a pudendal lymphatic fistula and cellulitis developed repeatedly. Lymphovascular anastomosis (LVA) and lymph vessel ligation were performed after preoperative evaluation via lymphoscintigraphy and indocyanine green (ICG) lymphography. A radioisotope injected into the first interdigit pedal region flowed into the pudendal region via the inguinal lymph nodes at preoperative lymphoscintigraphy. Linear patterns were observed up to the half level of the crus, and stardust patterns occurred over the lower abdominal and pudendal regions at ICG lymphography. During surgery, ICG lymphography was also used to identify the site of the fistula. With the patient under local anesthesia, LVA was applied in the half crus and left inguinal regions, followed by ligation and division of lymph vessels flowing into the fistula. The region around the fistula was excised as a 1 × 3-cm tissue block. As of 5 months after surgery, no recurrence of lymphatic fistula or exacerbation of lymphedema has occurred. This case shows the effectiveness of preoperative ICG lymphography and lymphoscintigraphy followed by treatment via lymph vessel ligation and LVA for curative resolution of a lymphatic fistula. PMID:22935310

Mihara, Makoto; Hara, Hisako; Narushima, Mitsunaga; Mitsui, Kito; Murai, Noriyuki; Koshima, Isao


The role of primary care prescribers in the diagnosis and management of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections.  


Nosocomial infections caused by methicillin-resistant Staphylococcus aureus were first reported in the United States in the early 1960s. Beginning in the 1990s, healthy individuals from the community with no risk factors for resistant bacteria began presenting with methicillin-resistant Staphylococcus aureus infections, acquiring the name "community-associated methicillin-resistant Staphylococcus aureus" (CA-MRSA). CA-MRSA has a tendency to affect the skin and skin structures, generally in the form of abscesses and furuncles, carbuncles, and cellulitis. Cases of invasive infections including bacteremia, endocarditis, and necrotizing pneumonia have also been reported. A patient complaint of a "spider bite" is frequently associated with CA-MRSA. CA-MRSA and the traditional health care-associated methicillin-resistant Staphylococcus aureus are distinguished by their genetic composition, virulence factors, and susceptibility patterns to non-beta-lactam antibiotics. Appropriate management of CA-MRSA skin and skin structure infections includes incision and drainage of infected tissue and appropriate antimicrobial therapy. It has been suggested that when prevalence of CA-MRSA within a community eclipses 10%-15%, empiric use of non-beta-lactam antibiotics with in vitro activity against CA-MRSA be initiated when treating skin and skin structure infections. CA-MRSA retains susceptibility to a range of older antibiotics available in oral formulations such as minocycline, doxycycline, sulfamethoxazole-trimethoprim, moxifloxacin, levofloxacin, and clindamycin. Local susceptibility patterns and individual patient factors should guide the selection of antibiotics. PMID:19617720

Lawrence, Kenneth R; Golik, Monica V; Davidson, Lisa


[A case of prostate cancer associated with bisphosphonate-related osteonecrosis of the jaw followed by retropharyngeal abscess].  


A 67-year-old man with castration-resistant prostate cancer associated with multiple bone metastases had been treated with zoledronic acid and docetaxel. Although there was no evidence of damage around the right lower jaw bone, the patient complained of pain in May 2011, which worsened during the next 2 weeks and was followed by difficulty with breathing. Computed tomographic (CT) findings of the cervical area showed swelling of the cervical tissue with air and tightening of the trachea, suggesting cellulitis caused by gas gangrene. He was intubated and treated with antibiotics. On the 12th hospital day, CT scan revealed a pharyngeal abscess and we performed a drainage operation. On the 20th hospital day, bone of the intraoral lower jaw was exposed, revealing that the infection was caused by osteonecrosis. Additional CT findings showed the abscess extending to the mediastinum and multiple liver metastases. Although antibiotic therapy was continued, the patient died of liver failure on the 61st day. PMID:24113758

Soda, Tetsuji; Fukumoto, Ryo; Hayashi, Tetsuya; Oka, Daizo; Fujimoto, Nobumasa; Koide, Takuo



Early Presentation of Heterotopic Ossification Mimicking Pyomyositis - Two Case Reports -  

PubMed Central

Early diagnosis and treatment of heterotopic ossification (HO) is essential to the prevention of complications. It is difficult to diagnose HO in its initial phase because non-specific clinical manifestations, laboratory findings and imaging findings of immature HO may mimic other diseases such as cellulitis, osteomyelitis, thrombophlebitis, deep vein thrombosis and local infection with abscess. We experienced two cases of HO, which were misdiagnosed as pyomyositis at first by clinical signs and MRI findings indicating the deep infection; the extensive intramuscular ossification appeared later on. We observed an increase of C-reactive protein and creatine kinase followed by the elevation of alkaline phosphatase with abnormal triphasic bone scan. The trajectory of these biomarkers was analyzed to get more insight into the early stages of HO along with the imaging findings. Although our cases cannot be generalized as typical of immature HO, they clearly demonstrate that the change of specific biomarkers with a careful history taking and physical examination should be noted to detect HO as early as possible while avoiding confusion with other mimicking conditions.

Choi, Yoon-Hee; Kim, Kyoung-Eun; Lim, Sung-Hoon



Extensive subcutaneous emphysema resembling necrotizing fasciitis.  


Necrotizing fasciitis is an aggressive, invasive soft tissue infection. Because it can rapidly progress to patient instability, prompt diagnosis followed by urgent debridement is critical to decreasing mortality. Despite the importance of early diagnosis, necrotizing fasciitis remains a clinical diagnosis, with little evidence in the literature regarding the effectiveness of diagnostic tools or criteria. Common clinical findings are nonspecific, including pain, blistering, crepitus, and swelling with or without fever and a known infection source.This article describes a patient who was transferred to the authors' institution from another hospital, where she had been taken following seizure activity and was treated with antibiotics for suspected cellulitis at the intravenous catheter placement site on her left dorsal hand. On admission to the current authors' institution, she presented with pain and swelling in the setting of significant left upper-extremity emphysema. She had undergone a left shoulder arthroscopy 4 weeks previously. Vital signs were within normal limits, and a preoperative chest radiograph was read as normal. The patient underwent an emergent fasciotomy, irrigation and debridement of the left upper extremity, and intravenous antibiotics for suspected necrotizing fasciitis. Intraoperative findings indicative of infection were absent, and a left apical pneumothorax was later found on postoperative chest imaging.In a stable patient with a normal chest radiograph on presentation who demonstrates upper-extremity crepitus suspicious for necrotizing fasciitis, a chest computed tomography scan may be indicated to rule out an intrathoracic source. PMID:23672900

Kamal, Robin N; Paci, Gabrielle M; Born, Christopher T



Complications of nephrotic syndrome  

PubMed Central

Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.

Park, Se Jin



Efficacy of antibiotic-impregnated polymethylmethacrylate beads in a rhesus macaque (Macaca mulatta) with osteomyelitis.  


Here we describe the successful surgical implementation of antibiotic-impregnated polymethylmethacrylate beads in a rhesus macaque (Macaca mulatta) with marked osteomyelitis. The macaque presented to the veterinary clinic with grossly contaminated bite wounds in the left ankle secondary to conspecific trauma. Radiographic findings were highly suggestive of osteomyelitis. Additional differential diagnoses included bony infarct, fracture, and cellulitis. In light of the location of the lesion and extensive tissue trauma, the animal had a poor prognosis. Systemic, broad-spectrum antibiotics were instituted. After 2 wk of care, lesions did not respond to empirical therapies. On consultation, a veterinary orthopedic surgeon at another facility recommended placement of antibiotic-impregnated polymethylmethacrylate beads at the sites of osteomyelitis. The animal underwent minor surgery in which beads were introduced into the wound. The monkey had a positive response to therapy. The animal regained full function and was returned to outdoor social housing. Veterinarians are encouraged to consider using antibiotic-impregnated polymethylmethacrylate beads when treating osteomyelitis in other nonhuman primates and in other traditional laboratory animal species. PMID:23043785

Kelly, Kristi R; Kapatkin, Amy R; Zwingenberger, Allison L; Christe, Kari L



Process for the preparation of a non-corrosive base solution and methods of using same  

US Patent & Trademark Office Database

The present invention provides novel methods of making a non-corrosive base solution for use as an alkalinity increasing agent and/or antioxidant. The present invention further provides novel compositions and methods which can be used to provide relief from disorders related to or complicated by acidosis or excessive free radical or other reactive oxygen species production including, but not limited to, gout, Lesch-Nyhan syndrome, hemochromatosis, Alzheimer's, amyotropic lateral sclerosis, arthritis, atherosclerosis, cancer, cataracts, chronic obstructive pulmonary disease, diabetes, cellulitis, coronary artery disease, heart failure, hypertension, inflammatory bowel disease, macular degeneration, multiple sclerosis, Parkinson's, Reynaud's phenomenon, reperfusion injury, pancreatic impairment, skin infections, Hepatitis C, methicillin-resistant Staphylococcus aureus and infection. The compositions and methods of the present invention additionally supply relief from microbial infections including fungal infections as well as prevent secondary infections. Additional compositions and methods are provided which employ a non-corrosive base solution in combination with a second alkalinity increasing agent and/or antioxidant, or other therapeutic agent to yield a more effective treatment tool against acidosis and/or excessive ROS production including free radical production useful to prevent or reduce acidosis and/or excessive ROS production or related symptoms or conditions associated with acidosis and/or excessive free radical production in mammalian subjects.

Wurzberger; Stephen Ray (Goodyears Bar, CA)



Regional odontodysplasia (Ghost teeth). A case report.  


Regional odontodysplasia is a rare development anomaly affecting the teeth with an unknown etiology. This dental abnormality involves the hard tissues of the teeth that are derived from both epithelial (enamel) and mesenchymal (dentine & cementum) components of the tooth forming apparatus. Teeth in a region or quadrant of maxilla or mandible are affected to the extent that they exhibit short roots, wide open apical foramen and large pulp chamber, the thinness and poor mineralisation qualities of th enamel and dentine layers have given rise to a faint radiolucent image, hence the term "Ghost teeth". Both the permanent teeth and the deciduous teeth are affected. Females are more commonly affected than males. There is a maxillary predominance (2.5:1) with a predilection for the anterior teeth. Eruption of the affected teeth is delayed or does not occur. Because of the poor quality of the affected teeth, they cannot be rehabilitated for functional use therefore the treatment of choice is extraction with prosthetic replacement. However, necrosis and facial cellulitis appear to be a complication if these teeth are retained. A unique case of regional odontodysplasia affecting the entire right quadrant of mandible is reported here. PMID:11987665

Kannan, S K; Saraswathi, K


Prevalence of toenail onychomycosis among diabetics at a primary care facility in Malaysia.  


Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p < 0.05). There were no significant correlations with gender, ethnic group, duration of diabetes, types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high. PMID:24050080

Leelavathi, M; Azimah, M N; Kharuddin, N F; Tzar, M N



[Skin complications of stonefish envenomation in 6 travellers returning from the Indo-Pacific maritime region].  


Stonefish (Synanceja verrucosa) sting has been known for a long time to be a medical hazard. It is a common cause of severe marine envenomation. Immediate complications (collapsus, pulmonary oedema) have been described extensively. Late complications (oedema, tissue necrosis) have not been studied in details although they are common and a cause of invalidity and pain. We have observed six travellers with complications of stonefish sting over a 10 year-period in our department. All the patients were coming back from the Indo-Pacific maritime region. They presented with cutaneous abcess (in one) or necrotic complications (foot ulcers in two, cellulitis in three) associated with painfull oedema in two and lymphangitis in three. Surgery has been performed in four patients, two of them undergoing many operations. Two had long term sequelae. Such complications could be avoided. Appropriate initial treatment (i.e., neutralization of the venom by hot water, disinfection, antivenom and antibioprophylaxis) seems to be able to reduce late complications. Antivenom is indicated in severe systemic manifestations which are life threatening and in case of crucial pains. Prevention is the most important part of therapy and relies on appropriate information of the travellers. PMID:15015852

Louis-Francois, C; Mathoulin, C; Halbwachs, C; Grivois, J P; Bricaire, F; Caumes, E



Characterization of transcription within sdr region of Staphylococcus aureus  

PubMed Central

Staphylococcus aureus is an opportunistic pathogen responsible for various infections in humans and animals. It causes localized and systemic infections, such as abscesses, impetigo, cellulitis, sepsis, endocarditis, bone infections, and meningitis. S. aureus virulence factors responsible for the initial contact with host cells (MSCRAMMs—microbial surface components recognizing adhesive matrix molecules) include three Sdr proteins. The presence of particular sdr genes is correlated with putative tissue specificity. The transcriptional organization of the sdr region remains unclear. We tested expression of the sdrC, sdrD, or sdrE genes in various in vitro conditions, as well as after contact with human blood. In this work, we present data suggesting a separation of the sdr region into three transcriptional units, based on their differential reactions to the environment. Differential reaction of the sdrD transcript to environmental conditions and blood suggests dissimilar functions of the sdr genes. SdrE has been previously proposed to play role in bone infections, whilst our results can indicate that sdrD plays a role in the interactions between the pathogen and human immune system, serum or specifically reacts to nutrients/other factors present in human blood.

Sitkiewicz, Izabela; Babiak, Ireneusz



Infective endocarditis complicated by aortic graft infection and osteomyelitis: case report and review of literature  

PubMed Central

Primary aortic graft infection early after aortic graft insertion is well described in the literature. Here, we present a unique case of late aortic graft infection 5 years after insertion secondary to mitral valve endocarditis, resulting from cellulitis in a patient with severe venous varicosities. A 63-year-old male presented for severe low back pain, constipation, and low-grade fever. An abdominal computed tomography scan with oral and intravenous contrast showed a normal spine and urinary tract. Blood and urine cultures, done at the same time, grew Staphylococcus aureus. A transesophageal echocardiogram confirmed the diagnosis of endocarditis. Subsequently, a gallium scan showed increased uptake in the vertebral bodies, aortic graft, left patella, and left ankle. After 3 months of antibiotic therapy, the patient’s low back pain resolved with normalization of his laboratory values. He remained free of infection at a 2-year follow-up. We reviewed the literature concerning the atypical presentation of infective endocarditis, with a focus on distant metastases at initial presentation, such as osteomyelitis and aortic graft infection, as well as the different treatment modalities. This report describes successful medical treatment with intravenous followed by oral antibiotics for an infected endovascular graft without any surgical intervention.

Zouein, Elie; Wetz, Robert; Mobarakai, Neville; Hassan, Samer; Tong, Iris



Mesures experimentales de l'impact des revetements hydrophobeset superhydrophobes sur la trainee et la portance d'un profil aerodynamique propre et glace  

NASA Astrophysics Data System (ADS)

Ce projet, realise a la demande du Laboratoire International des Materiaux Antigivre, a pour but de mesurer et definir experimentalement l'impact de revetements hydrophobes sur les coefficients de trainee et de portance d'un profil NACA 0012. Pour ce faire, la balance aerodynamique du LIMA devait tout d'abord etre amelioree afin d'offrir une sensibilite suffisante pour realiser le projet. Plusieurs ameliorations ont ete faites, comme le changement des cellules de charge, la diminution du nombre de cellules de charge, le changement du cadre de la balance, etc. Une fois ces ameliorations terminees, la reproductibilite, l'exactitude et la sensibilite ont ete valides afin de s'assurer de la fiabilite des resultats offerts par la balance. Pour les angles d'attaque etudies avec les revetements, soient -6° et 0°, la balance a une reproductibilite de +/-2,06% a 360 000 de nombre de Reynolds. Pour valider la sensibilite, des essais a -6° et 0° d'angle d'attaque et des nombres de Reynolds de 360 000 et 500 000 ont ete faits avec des papiers sables. Les resultats de ces essais ont permis de, tracer des courbes de tendances du coefficient de trainee du NACA 0012 en fonction de la rugosite de surface et d'etablir la valeur de la sensibilite de la balance a +/-8 mu m. Cinq revetements populaires ont ete choisis pour l'experimentation, soient le Wearlon, le Staclean, le Hirec, le Phasebreak ainsi que le Nusil. Les revetements sont soumis aux memes conditions experimentales que les papiers sables, et une rugosite equivalente est trouvee par extrapolation des resultats. Cependant, les rugosites equivalentes de surfaces different entre -6° et 0°. Les essais avec le Staclean et le Hirec donnent des coefficients de trainee equivalent a ceux avec l'aluminium, alors que le Wearlon, le Nusil et le Phasebreak donnent une augmentation du coefficient de trainee de 13%, 17% et 25% respectivement par rapport a l'aluminium. Pour les coefficients de portance, la balance ne detecte pas l'effet des revetements, ni des papiers sables, sur la force de portance ce qui signifie qu'il entre dans l'insensibilite de la balance. La derniere etape experimentale consistait a mesurer l'impact des revetements sur la formation de la glace ainsi que sur l'evolution des coefficients de trainee et de portance du NACA 0012 en fonction de l'accumulation de glace sur celui-ci. Le Wearlon a ete choisi comme revetement en raison de sa grande popularite. Des essais a -5°C et -20°C ont ete faits et les resultats ont montres que le Wearlon n'apporte pas d'effet benefique au NACA 0012 en conditions d'accumulations de glace. L'augmentation du coefficient de trainee du profil muni du Wearlon debutait plus rapidement que sur l'aluminium et de l'eau gelait legerement plus loin vers l'arriere du profil pendant les essais, ce qui n'est pas souhaitable. Le coefficient de trainee est superieur d'environ 13% pour le Wearlon par rapport a l'aluminium pendant toute l'accumulation de glace, ce qui correspond au meme ecart lorsque la glace n'est pas en cause. Pour le coefficient de portance, les resultats ne peuvent etre utilises pour une raison qui doit etre investiguee.

Villeneuve, Eric


Organ preservation at low temperature: a physical and biological problem  

NASA Astrophysics Data System (ADS)

Before reporting the preliminary results obtained by our group, we first review the main problems to be solved in the preservation of organs at very low temperature, before being transplanted. This cryopreservation is being presently explored in order to increase the preservation tiine of transplants and to contribute to a better control of the donor recipient compatibility. We recall that, for the isolated cells to be preserved at nitrogen liquid temperatures, as now successfully performed at industrial scale, it is necessary to immerse the cells in a solution containing more or less t,oxical additives (so-called cryopro tect ants). Furthermore cooling and warming rates must be specific of each type of cells. We then show that cryo preservation could be extrapolated to whole organs by means of vitrification, the only way to avoid any ice crystallization. This vitrification will be the result of two directions of research, the one on the elaboration of cryoprotective solutions, the least toxic possible, the other on the obtention of high enough and homogeneous cooling and warming rates. After having briefly summarized the state of research on the heart and kidneys of small mammals, we present the first results that we have obtained on perfusion at 4 ^{circ}C and the auto-transplantation of rabbit kidneys, on the toxicity of a new cryoprotectant, 2,3-butanediol, on the heart rate, and on the cooling of experimental models of organs. Avant de présenter les résultats préliminaires obtenus par notre groupe, nous passons d'abord en revue les principaux problèmes à résoudre pour conserver à très basse température des organes en vue de leur transplantation. Cette cryopréservation est une voie de recherche actuellement explorée pour augmenter la durée de conservation des greffons et permettre ainsi de mieux contrôler la compatibilité donneur-receveur. Nous rappelons que la conservation des cellules isolées à la température de l'azote liquide, actuellement réalisée avec succès à l'échelle industrielle, ne peut se faire qu'en présence de substances plus ou moins toxiques dites cryoprotectrices, et à condition de respecter des vitesses de refroidissement et de réchauffement adaptées à chaque type de cellule. Nous montrons ensuite que l'extension de la cryopréservation au cas des organes entiers ne pourra se faire qu'au moyen de la vitrification, seule solution pour éviter toute formation de glace. Cette vitrification sera l'aboutissement de 2 axes de recherche, l'un sur l'élaboration de solutions cryoprotectrices les moins toxiques possibles, l'autre sur l'obtention de vitesses de refroidissement et de réchauffement suffisamment élevées et homogènes. Après avoir brièvement résumé l'état des recherches sur le coeur et le rein de petits mammifères, nous présentons les premiers résultats que nous avons obtenus sur la perfusion à 4 ^{circ}C et l'autotransplantation de reins de lapin, sur la toxicité sur le coeur de rat d'un nouveau cryoprotecteur le 2,3-butanediol, et sur le refroidissement de systèmes modèles expérimentaux d'organes.

Aussedat, J.; Boutron, P.; Coquilhat, P.; Descotes, J. L.; Faure, G.; Ferrari, M.; Kay, L.; Mazuer, J.; Monod, P.; Odin, J.; Ray, A.



In Vivo Bioluminescence Imaging To Evaluate Systemic and Topical Antibiotics against Community-Acquired Methicillin-Resistant Staphylococcus aureus-Infected Skin Wounds in Mice  

PubMed Central

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes skin and soft tissue infections, including impetigo, cellulitis, folliculitis, and infected wounds and ulcers. Uncomplicated CA-MRSA skin infections are typically managed in an outpatient setting with oral and topical antibiotics and/or incision and drainage, whereas complicated skin infections often require hospitalization, intravenous antibiotics, and sometimes surgery. The aim of this study was to develop a mouse model of CA-MRSA wound infection to compare the efficacy of commonly used systemic and topical antibiotics. A bioluminescent USA300 CA-MRSA strain was inoculated into full-thickness scalpel wounds on the backs of mice and digital photography/image analysis and in vivo bioluminescence imaging were used to measure wound healing and the bacterial burden. Subcutaneous vancomycin, daptomycin, and linezolid similarly reduced the lesion sizes and bacterial burden. Oral linezolid, clindamycin, and doxycycline all decreased the lesion sizes and bacterial burden. Oral trimethoprim-sulfamethoxazole decreased the bacterial burden but did not decrease the lesion size. Topical mupirocin and retapamulin ointments both reduced the bacterial burden. However, the petrolatum vehicle ointment for retapamulin, but not the polyethylene glycol vehicle ointment for mupirocin, promoted wound healing and initially increased the bacterial burden. Finally, in type 2 diabetic mice, subcutaneous linezolid and daptomycin had the most rapid therapeutic effect compared with vancomycin. Taken together, this mouse model of CA-MRSA wound infection, which utilizes in vivo bioluminescence imaging to monitor the bacterial burden, represents an alternative method to evaluate the preclinical in vivo efficacy of systemic and topical antimicrobial agents.

Guo, Yi; Ramos, Romela Irene; Cho, John S.; Donegan, Niles P.; Cheung, Ambrose L.



Clinical and Microbiologic Characteristics of Invasive Streptococcus pyogenes Infections in North and South India  

PubMed Central

The lack of epidemiologic data on invasive Streptococcus pyogenes infections in many developing countries is concerning, as S. pyogenes infections are commonly endemic in these areas. Here we present the results of the first prospective surveillance study of invasive Streptococcus pyogenes infections in India. Fifty-four patients with invasive S. pyogenes infections were prospectively enrolled at two study sites, one in the north and one in the south of India. Sterile-site isolates were collected, and clinical information was documented using a standardized questionnaire. Available acute-phase sera were tested for their ability to inhibit superantigens produced by the patient's own isolate using a cell-based neutralizing assay. The most common clinical presentations were bacteremia without focus (30%), pneumonia (28%), and cellulitis (17%). Only two cases of streptococcal toxic shock syndrome and no cases of necrotizing fasciitis were identified. Characterization of the isolates revealed great heterogeneity, with 32 different emm subtypes and 29 different superantigen gene profiles being represented among the 49 sterile-site isolates. Analyses of acute-phase sera showed that only 20% of the cases in the north cohort had superantigen-neutralizing activity in their sera, whereas 50% of the cases from the south site had neutralizing activity. The results demonstrate that there are important differences in both clinical presentation and strain characteristics between invasive S. pyogenes infections in India and invasive S. pyogenes infections in Western countries. The findings underscore the importance of epidemiologic studies on streptococcal infections in India and have direct implications for current vaccine developments.

Haggar, Axana; Nerlich, Andreas; Kumar, Rajesh; Abraham, Vinod J.; Brahmadathan, Kootallur N.; Ray, Pallab; Dhanda, Vanita; Joshua, John Melbin Jose; Mehra, Narinder; Bergmann, Rene; Chhatwal, G. Singh



Methodology for evaluating Insite: Canada's first medically supervised safer injection facility for injection drug users  

PubMed Central

Many Canadian cities are experiencing ongoing infectious disease and overdose epidemics among injection drug users (IDUs). In particular, Human Immunodeficiency Virus (HIV) and hepatitis C Virus (HCV) have become endemic in many settings and bacterial and viral infections, such as endocarditis and cellulitis, have become extremely common among this population. In an effort to reduce these public health concerns and the public order problems associated with public injection drug use, in September 2003, Vancouver, Canada opened a pilot medically supervised safer injecting facility (SIF), where IDUs can inject pre-obtained illicit drugs under the supervision of medical staff. The SIF was granted a legal exemption to operate on the condition that its impacts be rigorously evaluated. In order to ensure that the evaluation is appropriately open to scrutiny among the public health community, the present article was prepared to outline the methodology for evaluating the SIF and report on some preliminary observations. The evaluation is primarily structured around a prospective cohort of SIF users, that will examine risk behavior, blood-borne infection transmission, overdose, and health service use. These analyses will be augmented with process data from within the SIF, as well as survey's of local residents and qualitative interviews with users, staff, and key stakeholders, and standardised evaluations of public order changes. Preliminary observations suggest that the site has been successful in attracting IDUs into its programs and in turn helped to reduce public drug use. However, each of the indicators described above is the subject of a rigorous scientific evaluation that is attempting to quantify the overall impacts of the site and identify both benefits and potentially harmful consequences and it will take several years before the SIF's impacts can be appropriately examined.

Wood, Evan; Kerr, Thomas; Lloyd-Smith, Elisa; Buchner, Chris; Marsh, David C; Montaner, Julio SG; Tyndall, Mark W



Single-institution outcome experience using AlloDerm® as temporary coverage or definitive reconstruction for cutaneous and soft tissue malignancy defects.  


Definitive reconstruction after excision of cutaneous and soft tissue malignancies is sometimes limited as a result of lack of native tissue coverage options, patient comorbidities, or pending permanent margin analysis. Acellular dermis (AlloDerm®) reconstruction offers an excellent coverage alternative in these situations. We describe our experience using AlloDerm for coverage of skin and soft tissue defects. An Institutional Review Board approved review of patients undergoing skin/soft tissue coverage with AlloDerm from 2006 to 2012 was performed. Clinicopathologic variables, early postoperative findings, and subjective final cosmetic outcome were analyzed. Sixty-seven patients underwent AlloDerm reconstruction. Melanoma (67%) was the most frequent diagnosis. The median defect size was 42 cm(2) (range, 2 to 340 cm(2)), involving predominantly the lower extremity (45%) or head and neck (32%). AlloDerm was intended for use as a temporary dressing in 64 per cent (43 of 67) and permanent coverage in 24 (36%). Ten patients required reexcision for positive margins. Twenty-five (37%) underwent split-thickness skin graft or flap coverage after AlloDerm placement. Radiation was administered to 16 patients (24%) after AlloDerm reconstruction within a median of 53 days after surgery (range, 18 to 118 days). At first postoperative examination (median, 11 days after surgery), 85 per cent had evidence of healthy AlloDerm incorporation. Cellulitis was the most frequent complication (13%), all resolving with oral antibiotics. AlloDerm reconstruction after skin and soft tissue resection offers a suitable coverage alternative and may serve as a bridge to permanent reconstruction or as a permanent biologic dressing of complex surgical defects. In situations in which adjuvant radiation is needed, AlloDerm can be used without major complications. PMID:23635582

Deneve, Jeremiah L; Turaga, Kiran K; Marzban, Suroosh S; Puleo, Christopher A; Sarnaik, Amod A; Gonzalez, Ricardo J; Sondak, Vernon K; Zager, Jonathan S



Primary ophthalmic rhabdomyosarcoma in 33 patients.  

PubMed Central

PURPOSE: To review the findings, management, and outcome in 33 cases of primary ophthalmic rhabdomyosarcoma. METHODS: The records of 33 consecutive patients from a single ocular oncology center were analyzed retrospectively for outcomes of final visual acuity, local recurrence, and distant metastasis. RESULTS: Rhabdomyosarcoma was primarily located in the orbit m 25 cases (76%), conjunctiva in 4 (12%), eyelid in 1 (3%), and uveal tract in 3 (9%). Findings had been present for a mean of 5 weeks and included proptosis in 10 patients (30%), eyelid swelling in 7 (21%), and blepharoptosis in 6 (18%). The initial diagnoses before referral to us included primarily rhabdomyosarcoma in 8 cases (24%), conjunctivitis in 5 (15%), cellulitis in 5 (15%), and pseudotumor in 4 (12%). Tumors were classified according to the Intergroup Rhabdomyosarcoma Study Group staging and treatment protocols as group I in 4 cases (12%), group II in 12 (36%), group III in 16 (48%), and group IV in 1 case (3%). Treatment included surgical debulking, chemotherapy, and radiotherapy. Local tumor recurrence was detected in 6 patients (18%), lymph node spread in 2 (6%), and distant metastasis in 2 (6%). Long-term visual outcome of the 28 patients who maintained their globe was 20/20 to 20/40 in 11 patients (39%), 20/50 to 20/100 in 5 (18%), and 20/200 or worse in 12 (43%). Mean follow-up was 8.3 years; tumor-related death occurred in 1 patients (3%). CONCLUSIONS: Rhabdomyosarcoma can present in the orbit, eyelid, conjunctiva, and uveal tract. Following treatment, local tumor recurrence occurs in 18% of cases, metastasis in 6%, and death in 3%.

Shields, C L; Shields, J A; Honavar, S G; Demirci, H



Le lymphomes non hodgkinien primitif de la thyro?de: ? propos de sept cas  

PubMed Central

Les lymphomes non hodgkiniens primitifs de la thyroïde sont rares : ils représentent moins de 2 à 5 % des cancers de la thyroïde. L'objectif de ce travail est de revoir les stratégies diagnostiques et thérapeutiques actuelles des lymphomes non hodgkiniens primitifs de la thyroïde tout en présentant notre expérience à l'Institut national d'oncologie. Nous rapportons à travers une étude rétrospective, sept cas des lymphomes non hodgkiniens primitifs de la thyroïde colligés à l'Institut National d'Oncologie au Maroc entre 2004 et 2008. Sept patients ont été inclus dans notre étude, l’âge médian au moment du diagnostic était de 50 ans, avec sexe ratio de 2.5 à prédominance féminine. Le diagnostic histopathologique avec l'immunomarquage après chirurgie a conclu dans tous les cas à un lymphome malin non hodgkinien : 3 patientes avec un lymphome de type MALT, et les 4 autres avec un LMNH à grandes cellules de phénotype B. Une thyroïdite chronique lymphocytaire d'Hashimoto coexistante avec le lymphome malin primitif de la thyroïde était retrouvée chez une patiente. Concernant le traitement du lymphome, 5 patientes ont reçu une polychimiothérapie, et les 2 autres ont bénéficié d'un traitement combiné comportant la chimiothérapie et la radiothérapie. Une patiente est décédée 3 mois après la fin du traitement. Le suivi médian des autres patients était de 24 mois et on ne notait aucune récidive de lymphome. Les lymphomes non hodgkiniens primitifs de la thyroïde sont rares. Le traitement combiné par une chimiothérapie et radiothérapie a prouvé son efficacité. Le pronostic des stades localisés est généralement favorable.

Chenna, Hanane; Berhil, Hanane; Nouni, Karima; Kabbaj, Hanane; Zaidi, Hanane; Toulba, Ahmedou; El Kacemi, Hanan; Hassouni, Khalid; Kebdani, Tayeb; El Gueddari, Brahim Khalil; Benjaafar, Noureddine



Fournier's gangrene developing secondary to infected hydrocele: A unique clinical scenario  

PubMed Central

We report the first case of Fournier's gangrene (FG) developing secondary to an infected hydrocele worldwide. We present a case report with a brief overview of the literature relating to FG and its aetiology, diagnosis and management. A 70 year-old male was referred by his General Practitioner with a 2 week history of worsening symptoms of scrotal discomfort and swelling. Following clinical examination, an initial diagnosis of an infected right-sided hydrocele was made and treatment, consisting of antibiotics, was initiated. Despite showing good clinical improvement, several days later, necrotic areas were observed over the right hemiscrotum with spreading cellulitis. A diagnosis of FG was made. The patient was started on triple–therapy antibiotics and taken to the operating room for urgent surgical debridement. Necrotic skin and subcutaneous tissue extending over the perineum and lower anterior abdomen was debrided down to healthy tissue. A further debridement took place 2 days later. The patient continued to improve and was eventually discharged under the care of Plastic Surgeons for reconstruction of the soft tissue defect. FG is a type of necrotising fasciitis predominantly affecting the male perineal, perianal, genital and anterior abdominal wall regions. It has a significant mortality rate, and the key to survival is early detection and treatment consisting of antibiotics and surgical debridement of the affected area. To the best of our knowledge, this is the first reported case of FG developing secondary to an existing hydrocele without any prior urological intervention. The case highlights the important clinical diagnostic and therapeutic interventions required to prevent complications associated with this, potentially fatal, condition.

Sarwar, Umran; Akhtar, Nadeem



Feasibility and Effectiveness of Indicator Condition-Guided Testing for HIV: Results from HIDES I (HIV Indicator Diseases across Europe Study)  

PubMed Central

Improved methods for targeting HIV testing among patients most likely to be infected are required; HIDES I aimed to define the methodology of a European wide study of HIV prevalence in individuals presenting with one of eight indicator conditions/diseases (ID); sexually transmitted infection, lymphoma, cervical or anal cancer/dysplasia, herpes zoster, hepatitis B/C, mononucleosis-like illness, unexplained leukocytopenia/thrombocytopenia and seborrheic dermatitis/exanthema, and to identify those with an HIV prevalence of >0.1%, a level determined to be cost effective. A staff questionnaire was performed. From October 2009– February 2011, individuals, not known to be HIV positive, presenting with one of the ID were offered an HIV test; additional information was collected on previous HIV testing behaviour and recent medical history. A total of 3588 individuals from 16 centres were included. Sixty-six tested positive for HIV, giving an HIV prevalence of 1.8% [95% CI: 1.42–2.34]; all eight ID exceeded 0.1% prevalence. Of those testing HIV positive, 83% were male, 58% identified as MSM and 9% were injecting drug users. Twenty percent reported previously having potentially HIV-related symptoms and 52% had previously tested HIV negative (median time since last test: 1.58 years); which together with the median CD4 count at diagnosis (400 cell/uL) adds weight to this strategy being effective in diagnosing HIV at an earlier stage. A positive test was more likely for non-white individuals, MSM, injecting drug users and those testing in non-Northern regions. HIDES I describes an effective strategy to detect undiagnosed HIV infection. All eight ID fulfilled the >0.1% criterion for cost effectiveness. All individuals presenting to any health care setting with one of these ID should be strongly recommended an HIV test. A strategy is being developed in collaboration with ECDC and WHO Europe to guide the implementation of this novel public health initiative across Europe.

Sullivan, Ann K.; Raben, Dorthe; Reekie, Joanne; Rayment, Michael; Mocroft, Amanda; Esser, Stefan; Leon, Agathe; Begovac, Josip; Brinkman, Kees; Zangerle, Robert; Grzeszczuk, Anna; Vassilenko, Anna; Hadziosmanovic, Vesna; Krasnov, Maksym; Sonnerborg, Anders; Clumeck, Nathan; Gatell, Jose; Gazzard, Brian; Monforte, Antonella d'Arminio; Rockstroh, Jurgen; Lundgren, Jens D.



The Centenary of Janssens's Chiasmatype Theory  

PubMed Central

The segregation and random assortment of characters observed by Mendel have their basis in the behavior of chromosomes in meiosis. But showing this actually to be the case requires a correct understanding of the meiotic behavior of chromosomes. This was achieved only gradually, over several decades, with much dispute and confusion along the way. One crucial step in the understanding of meiosis was provided in 1909 by Frans Alfons Janssens who published in La Cellule an article entitled “La théorie de la Chiasmatypie. Nouvelle interprétation des cinèses de maturation,” which contains the first description of the chiasma structure. He observed that, of the four chromatids present at the connection sites (chiasmata sites) at diplotene or anaphase of the first meiotic division, two crossed each other and two did not. He therefore postulated that the maternal and paternal chromatids that crossed penetrated the other until they broke and rejoined in maternal and paternal segments new ways; the other two chromatids remained free and thus intact. This allowed him also to propose that the chromatids distributed in the four nuclei issued from the second meiotic division had various combinations of maternal and paternal segments of each chromosome. And conversely, permitted the appreciation that the laws of Mendelian segregation required breakage and joining (crossing over) between homologous non-sister chromatids. Although Janssens’s article found a broad appreciative audience and had a large influence on the chromosomal theory at that time, his theory was resisted by both geneticists and cytologists for several decades. This Perspectives aims to highlight the novelty of Janssens’s chiasmatype theory by examining the historical background and our actual understanding of meiotic recombination.

Koszul, Romain; Meselson, Matthew; Van Doninck, Karine; Vandenhaute, Jean; Zickler, Denise



Utilisation de traceurs radioactifs pour l'évaluation du recrutement des leucocytes et des échanges vasculaires au niveau d'organes in~vivo. Description d'une méthode et discussion des problèmes d'interprétation sur quelques exemples  

NASA Astrophysics Data System (ADS)

An experimental method using simultaneously different ? emiter tracers was developed to evaluate inflammation in vivo. Experiments were performed on the anaesthetized guinea-pig to test pulmonary effects of inflammatory agents. Red blood cells, albumin and inflammatory cells (platelets or leucocytes) radiolabelled with 99m technetium, 131 iodine and 111 indium respectively were injected i.v. Their radioactivities were measured on a pulmonary region by external detection and on blood samples in a well type counter. From these measurements variations of the lung contents in red blood cells, extravascular albumin and non circulating leucocytes during inflammatory stimulation were evaluated. These parameters axe indexes of blood perfusion, vascular exchanges and leucocyte sequestration respectively. Fiability of the method and meaning of the parameters evaluated are discussed. Une méthode expérimentale utilisant simultanément différents traceurs ? a été développée pour évaluer l'inflammation in vivo. Des expériences ont été réalisées chez le cobaye anesthésié pour tester l'effet pulmonaire d'agents inflammatoires. Des globules rouges, de l'albumine et des cellules inflammatoires (plaquettes ou leucocytes) radiomarqués respectivement au technetium 99m, à l'iode 131 et à l'indium 111 sont injectés i.v. Leurs radioactivités sont mesurées sur une région pulmonaire par détection externe et sur des échantillons sanguins au compteur puit. À partir de ces mesures sont évaluées les variations des contenus pulmonaires en globules rouges, en albumine extravasculaire et en leucocytes non circulants lors d'une stimulation inflammatoire. Ces paramètres sont corrélés aux modifications de la perfusion, des échanges vasculaires et de la séquestration leucocytaire. La fiabilité de la méthode et la signification des paramètres évalués sont discutées.

Bureau, M. F.



Linezolid versus Vancomycin in Treatment of Complicated Skin and Soft Tissue Infections  

PubMed Central

Skin and soft tissue infections (SSTIs) are a common cause of morbidity in both the community and the hospital. An SSTI is classified as complicated if the infection has spread to the deeper soft tissues, if surgical intervention is necessary, or if the patient has a comorbid condition hindering treatment response (e.g., diabetes mellitus or human immunodeficiency virus). The purpose of this study was to compare linezolid to vancomycin in the treatment of suspected or proven methicillin-resistant gram-positive complicated SSTIs (CSSTIs) requiring hospitalization. This was a randomized, open-label, comparator-controlled, multicenter, multinational study that included patients with suspected or proven methicillin-resistant Staphylococcus aureus (MRSA) infections that involved substantial areas of skin or deeper soft tissues, such as cellulitis, abscesses, infected ulcers, or burns (<10% of total body surface area). Patients were randomized (1:1) to receive linezolid (600 mg) every 12 h either intravenously (i.v.) or orally or vancomycin (1 g) every 12 h i.v. In the intent-to-treat population, 92.2% and 88.5% of patients treated with linezolid and vancomycin, respectively, were clinically cured at the test-of-cure (TOC) visit (P = 0.057). Linezolid outcomes (124/140 patients or 88.6%) were superior to vancomycin outcomes (97/145 patients or 66.9%) at the TOC visit for patients with MRSA infections (P < 0.001). Drug-related adverse events were reported in similar numbers in both the linezolid and the vancomycin arms of the trial. The results of this study demonstrate that linezolid therapy is well tolerated, equivalent to vancomycin in treating CSSTIs, and superior to vancomycin in the treatment of CSSTIs due to MRSA.

Weigelt, John; Itani, Kamal; Stevens, Dennis; Lau, William; Dryden, Matthew; Knirsch, Charles



The centenary of Janssens's chiasmatype theory.  


The segregation and random assortment of characters observed by Mendel have their basis in the behavior of chromosomes in meiosis. But showing this actually to be the case requires a correct understanding of the meiotic behavior of chromosomes. This was achieved only gradually, over several decades, with much dispute and confusion along the way. One crucial step in the understanding of meiosis was provided in 1909 by Frans Alfons Janssens who published in La Cellule an article entitled "La théorie de la Chiasmatypie. Nouvelle interprétation des cinèses de maturation," which contains the first description of the chiasma structure. He observed that, of the four chromatids present at the connection sites (chiasmata sites) at diplotene or anaphase of the first meiotic division, two crossed each other and two did not. He therefore postulated that the maternal and paternal chromatids that crossed penetrated the other until they broke and rejoined in maternal and paternal segments new ways; the other two chromatids remained free and thus intact. This allowed him also to propose that the chromatids distributed in the four nuclei issued from the second meiotic division had various combinations of maternal and paternal segments of each chromosome. And conversely, permitted the appreciation that the laws of Mendelian segregation required breakage and joining (crossing over) between homologous non-sister chromatids. Although Janssens's article found a broad appreciative audience and had a large influence on the chromosomal theory at that time, his theory was resisted by both geneticists and cytologists for several decades. This Perspectives aims to highlight the novelty of Janssens's chiasmatype theory by examining the historical background and our actual understanding of meiotic recombination. PMID:22701050

Koszul, Romain; Meselson, Matthew; Van Doninck, Karine; Vandenhaute, Jean; Zickler, Denise



False-positive diatom test: a real challenge? A post-mortem study using standardized protocols.  


The main criticism of the validity of the diatom test for the diagnosis of drowning is based on the potential ante- and post-mortem penetration of diatoms and the finding of diatoms in bodies of non-drowned human beings. However, qualitative and quantitative studies on diatoms in organs of the non-drowned have yielded both conflicting and contradictory results. In the present study, we have analysed under standardised methods the diatom content in several organs of 14 non-drowned human bodies. Overall, only 9 diatoms (6 entire, 3 fragmented) were disclosed in 6 of the 14 non-drowned bodies. Each of these 6 cadavers had only a single "positive" organ. Six diatoms were found in the bone marrow, 2 in the lung, and one in the pleural liquid. No diatoms were recovered from the brain, liver, kidney, or blood samples of any of these 14 bodies. Moreover, in five additional cadavers, whose lungs were injected, prior autopsy, with a 3.5L solution containing a bi-cellulate diatom culture (Thalassiosira baltica, Thalassiosira levanderi) via tracheostomy, a few diatoms appeared in the pleural cavity and in the blood from the left heart chamber, but none in any other internal organs investigated. The results of the presented study demonstrate that the issue of the false-positive diatom test should not be a logical impediment to the performance of the diatom method. However, strict and standardized protocols aimed at avoiding contamination during sample preparation must be used, appropriate separation values set and taxonomic analysis of all diatoms performed. PMID:23701706

Lunetta, Philippe; Miettinen, Arto; Spilling, Kristian; Sajantila, Antti



Optimisation of Arabidopsis thaliana DNA extraction for the analysis of 8-oxo-7,8-dihydro-2'-deoxyguanosine formation after gamma irradiation  

NASA Astrophysics Data System (ADS)

8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo) is a major oxidative DNA lesion. Plant DNA extraction protocols were improved in order to quantify 8-oxodGuo in the overall DNA of a cell suspension of Arabidopsis thaliana using the method of high performance liquid chromatography with electrochemical detection (HPLC-EC). Our results show that DNA can be artefactually oxidised during the extraction procedure. Metal chelating agents were efficient to decrease the 8-oxodGuo background level to 3.3 ± 0.1 8-oxodGuo/105Gua and to improve experiment reproducibility. It was observed that DNA guanine oxidation in plant cells by ?-rays is very low in vivo (15 8-oxodGuo/10^9Gua formation per Gy). La 8-oxo-7,8-dihydro-2'-désoxyguanosine (8-oxodGuo) est une lésion oxydative majeure de l'ADN. Divers protocoles d'extraction d'ADN végétal ont été optimisés dans le but de quantifier la 8-oxodGuo dans l'ADN total d'une suspension cellulaire d'Arabidopsis thaliana en utilisant la chromatographie liquide haute pérformance couplée à un détecteur électrochimique (CLHP-EC). Nos résultats montrent que l'ADN peut être oxydé artéfactuellement au cours de son extraction. L'utilisation de chélateurs de métaux permet de réduire le niveau de base de 8-oxodGuo à 3,3±0,1 8-oxodGuo/10^5Gua et d'augmenter la reproductibilité des expériences. L'étude des effets des rayons ? sur les cellules de plantes a mis en évidence que l'oxydation de la guanine de l'ADN est très faible in vivo (formation de 15 8-oxodGuo/10^9Gua par Gy).

Dany, A. L.; Triantaphylidès, C.; Cadet, J.; Douki, T.



An outcome analysis of brachioplasty techniques following massive weight loss.  


Body contouring following massive weight loss (MWL) has gained in popularity. The demand for upper arm contouring procedures has increased, and we elected to evaluate our results, complications, and patient satisfaction with brachioplasty techniques in MWL patients. A retrospective review was performed on all patients who underwent a brachioplasty procedure. Patient demographics and risk factors were queried. We evaluated surgical techniques and outcomes. Thirty-one patients underwent a bilateral brachioplasty, with an average follow-up of 16 months. The surgical technique included double ellipse n = 16, and L-shaped n = 15. The average weight loss before the procedure was 146 pounds, and the average body mass index at the time of the surgery was 30. Risk factors were present in 68% of the patients. The complication rate was 22%, including cellulitis, hematoma, infection, delayed healing, and lymphocele. The revision rate was 16%, most being minor scar revisions for contour improvement. Patient satisfaction scores included overall satisfaction 4.3/5, contour improvement 4.3/5, symptomatic improvement 4.9/5, and scar appearance 3.9/5. Most patients (94%) reported improved self-esteem, 94% being more comfortable wearing short sleeve shirts, and 94% would undergo the procedure again. Brachioplasty is a relatively safe and effective procedure for upper body contouring in the MWL patient. Complications are minor, and small revisions in contour are not uncommon. Patients report improvement in contour and self-esteem, and a high level of satisfaction with this procedure, despite the potential for an unfavorable scar. PMID:20354431

Symbas, John D; Losken, Albert



Characterization of community acquired Staphylococcus aureus associated with skin and soft tissue infection in Beijing: high prevalence of PVL+ ST398.  


Adult community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and methicillin-susceptible S. aureus (CA-MSSA) skin and soft tissue infection (SSTI) in China is not well described. A prospective cohort of adults with SSTI was established between January 2009 and August 2010 at 4 hospitals in Beijing. Susceptibility testing and molecular typing, including multilocus sequence typing, spa, agr typing, and toxin detection were assessed for all S. aureus isolates. Overall, 501 SSTI patients were enrolled. Cutaneous abscess (40.7%) was the most common infection, followed by impetigo (6.8%) and cellulitis (4.8%). S. aureus accounted for 32.7% (164/501) of SSTIs. Five isolates (5/164, 3.0%) were CA-MRSA. The most dominant ST in CA-MSSA was ST398 (17.6%). The prevalence of Panton-Valentine Leukocidin (pvl) gene was 41.5% (66/159) in MSSA. Female, younger patients and infections requiring incision or drainage were more commonly associated with pvl-positive S. aureus (P<0.03); sec gene was more often identified in CC5 (P<0.03); seh gene was more prevalent in CC1 (P?=?0.001). Importantly, ST59 isolates showed more resistance to erythromycin, clindamycin and tetracycline, and needed more surgical intervention. In conclusion, CA-MRSA infections were rare among adult SSTI patients in Beijing. Six major MSSA clones were identified and associated with unique antimicrobial susceptibility, toxin profiles, and agr types. A high prevalence of livestock ST398 clone (17.1% of all S. aureus infections) was found with no apparent association to animal contact. PMID:22701673

Zhao, Chunjiang; Liu, Yingmei; Zhao, Mingze; Liu, Yali; Yu, Yong; Chen, Hongbin; Sun, Qiuning; Chen, Huawei; Jiang, Wei; Liu, Yudong; Han, Shaomei; Xu, Yingchun; Chen, Minjun; Cao, Bin; Wang, Hui



In vivo bioluminescence imaging to evaluate systemic and topical antibiotics against community-acquired methicillin-resistant Staphylococcus aureus-infected skin wounds in mice.  


Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes skin and soft tissue infections, including impetigo, cellulitis, folliculitis, and infected wounds and ulcers. Uncomplicated CA-MRSA skin infections are typically managed in an outpatient setting with oral and topical antibiotics and/or incision and drainage, whereas complicated skin infections often require hospitalization, intravenous antibiotics, and sometimes surgery. The aim of this study was to develop a mouse model of CA-MRSA wound infection to compare the efficacy of commonly used systemic and topical antibiotics. A bioluminescent USA300 CA-MRSA strain was inoculated into full-thickness scalpel wounds on the backs of mice and digital photography/image analysis and in vivo bioluminescence imaging were used to measure wound healing and the bacterial burden. Subcutaneous vancomycin, daptomycin, and linezolid similarly reduced the lesion sizes and bacterial burden. Oral linezolid, clindamycin, and doxycycline all decreased the lesion sizes and bacterial burden. Oral trimethoprim-sulfamethoxazole decreased the bacterial burden but did not decrease the lesion size. Topical mupirocin and retapamulin ointments both reduced the bacterial burden. However, the petrolatum vehicle ointment for retapamulin, but not the polyethylene glycol vehicle ointment for mupirocin, promoted wound healing and initially increased the bacterial burden. Finally, in type 2 diabetic mice, subcutaneous linezolid and daptomycin had the most rapid therapeutic effect compared with vancomycin. Taken together, this mouse model of CA-MRSA wound infection, which utilizes in vivo bioluminescence imaging to monitor the bacterial burden, represents an alternative method to evaluate the preclinical in vivo efficacy of systemic and topical antimicrobial agents. PMID:23208713

Guo, Yi; Ramos, Romela Irene; Cho, John S; Donegan, Niles P; Cheung, Ambrose L; Miller, Lloyd S



Necrotizing fasciitis  

PubMed Central

Abstract OBJECTIVE To describe the defining characteristics and treatment of necrotizing fasciitis (NF), emphasizng early diagnostic indications. QUALITY OF EVIDENCE PubMed was searched using the terms necrotizing fasciitis and necrotizing soft tissue infections, paired with early diagnosis. Results were limited to human studies in English. Additional articles were obtained from references within articles. Evidence is levels II and III. MAIN MESSAGE Necrotizing fasciitis is classified according to its microbiology (polymicrobial or monomicrobial), anatomy, and depth of infection. Polymicrobial NF mostly occurs in immunocompromised individuals. Monomicrobial NF is less common and affects healthy individuals who often have a history of trauma (usually minor). Patients with NF can present with symptoms of sepsis, systemic toxicity, or evidence of skin inflammation, with pain that is disproportional to the degree of inflammation. However, these are also present in less serious conditions. Hyperacute cases present with sepsis and quickly progress to multiorgan failure, while subacute cases remain indolent, with festering soft-tissue infection. Because the condition is rare with minimal specific signs, it is often misdiagnosed. If NF is suspected, histology of tissue specimens is necessary. Laboratory and radiologic tests can be useful in deciding which patients require surgical consultation. Once NF is diagnosed, next steps include early wound debridement, excision of nonviable tissue, and wide spectrum cover with intravenous antibiotics. CONCLUSION Necrotizing fasciitis is an uncommon disease that results in gross morbidity and mortality if not treated in its early stages. At onset, however, it is difficult to differentiate from other superficial skin conditions such as cellulitis. Family physicians must have a high level of suspicion and low threshold for surgical referral when confronted with cases of pain, fever, and erythema.

Puvanendran, Rukshini; Huey, Jason Chan Meng; Pasupathy, Shanker



The role of hypervirulent Staphylococcus aureus infections in the development of deep vein thrombosis.  


Patients with sepsis frequently have activated coagulation pathways triggered by tissue factor, reduced levels of anticoagulation factors, reduced fibrinolysis, activated endothelial surfaces, and activated platelets. These processes result in disseminated intravascular coagulation and microthrombus formation and contribute to multi-organ system failure. S aureus surface proteins and exotoxins can contribute to thrombus formation through effects on the coagulation pathway and on anticoagulation factors. In addition, S aureus can activate endothelial surfaces and platelets. Some exotoxins such as the Panton-Valentine leukocidin can cause leukocyte lysis and additional injury to endothelial surfaces. These events can cause microthrombosis and deep venous thrombosis. Several case series have described an association between acute hematogenous osteomyelitis secondary to S aureus and the development of deep venous thrombosis in extremities. In addition, a recent clinical case review of staphylococcal community-acquired pneumonia demonstrated that patients who died secondary to these infections frequently had deep venous thrombosis. These observations support the idea that S aureus can contribute to thrombus formation. We recently cared for a patient who developed splanchnic vein thrombosis during an episode of staphylococcal cellulitis associated with bacteremia and multi-organ system failure. The pathogenesis of splenic vein thrombosis differs from the pathogenesis of deep venous thrombosis in the extremities in some, but not all, respects. Clearly the presence of circulating staphylococci and associated proteins could contribute to the formation of thrombi in the splanchnic circulation. Patients with hypervirulent staphylococcal infections require evaluation for deep venous thrombosis in extremities and in unusual sites. The development of these clots has a potentially significant impact on management and outcome. This review considers the pathogenesis of deep vein thrombosis in patients with sepsis, the potential contributions of Staphylococcus aureus in this process, and clot formation in unusual locations which greatly increases the complexity of patient care. PMID:22771217

Martin, Eric; Cevik, Cihan; Nugent, Kenneth



Haemophilus influenzae infections in adults: report of nine cases and a review of the literature.  


Haemophilus influenzae is an aerobic pleomorphic gram-negative coccobacillus that requires both X and V factors for growth. It grows poorly, if at all, on ordinary blood agar unless streaked with Staph. aureus. It grows well on chocolate agar. Because this medium is often not used in culturing specimens from adults and because the organism may be overgrown by other bacteria, the frequency of H. influenzae infections has undoubtedly been seriously underestimated. This is aggravated by the failure of many physicians to obtain blood cultures in suspected bacterial infections and the failure of many laboratories to subculture them routinely onto chocolate agar. H. influenzae, along with Streptococcus pneumoniae, is a major factor in acute sinusitis. It is probably the most frequent etiologic agent of acute epiglottitis. It is probably a common, but commonly unrecognized, cause of bacterial pneumonia, where it has a distinctive appearance on Gram stain. It is unusual in adult meningitis, but should particularly be considered in alcoholics; in those with recent or remote head trauma, especially with cerebrospinal fluid rhinorrhea; in patients with splenectomies and those with primary or secondary hypogammaglobulinemia. It may rarely cause a wide variety of other infections in adults, including purulent pericarditis, endocarditis, septic arthritis, obstetrical and gynecologic infections, urinary and biliary tract infections, and cellulitis. Antimicrobial susceptibility testing is somewhat capricious in part from the marked effect of inoculum size in some circumstances. In vitro and in vivo results support the use of ampicillin, unless the organism produces beta-lactamase. Alternatives in minor infections include tetracycline, erythromycin, and sulfamethoxazole-trimethoprim. For serious infections chloramphenicol is the best choice if the organism is ampicillin-resistant or the patient is penicillin-allergic. PMID:310943

Hirschmann, J V; Everett, E D



Clinical-pathological characterization of diabetic foot infections: grading the severity of osteomyelitis.  


The present study has 3 aims: (a) to characterize the clinical and pathological features of diabetic foot infections, (b) to show the range of clinical presentations of moderate infections, and (c) to analyze the different behavior of diabetic foot osteomyelitis regarding to its clinical presentation. A definitive diagnosis of the type of infection was made based on intraoperative findings and histopathology. Diabetic foot infections were classified into 2 types: soft tissue and bone infections. Mild infections were always superficial. Severe infections included 75% of necrotizing soft tissue infections. Moderate infections showed ample range of clinical presentations. Eighty-one patients presented osteomyelitis. Osteomyelitis was further classified as follows: osteomyelitis without ischemia and without soft tissue involvement (class 1), osteomyelitis with ischemia without soft tissue involvement (class 2), osteomyelitis with soft tissue involvement (class 3), and osteomyelitis with ischemia and soft tissue involvement (class 4). Forty-eight patients (59.3%) with osteomyelitis underwent conservative surgery, 32 (39.5%) had minor amputations including 9 open transmetatarsal amputations, and there was 1 (1.2%) major amputation. The characterization of osteomyelitis into 4 classes showed a statistically significant trend toward increased severity and increased amputation rate and mortality. In conclusion, the clinical presentation of foot infections in diabetic patients is very heterogeneous and can be classified into soft tissue infections (cellulitis, superficial and deep abscesses, and necrotizing soft tissue infections) and osteomyelitis, which was the most frequent type of infection found in the author's series. Their division into 4 classes showed a statistically significant trend toward increased severity, amputation rate, and mortality. The diagnosis of deep soft tissue infections associated with osteomyelitis may be difficult to achieve before surgery. PMID:22582344

Aragón-Sánchez, Javier



[Fever in infants under the age of three months without sign of focal infection. Criteria of therapeutic decision].  


Fever is one of the most frequent signs seen in children at consultation. In infants under the age of 3 months, fever is nonspecific and is often the only sign of a potentially severe infection. It has been estimated that two-thirds of the children hospitalized have a viral infection and 10% a bacterial infection with risks of complications including meningitis. It must be recalled that 5% of the infants with septicaemia due to Haemophilus influenzae b who does not receive an appropriate treatment will develop meningitis or another focal infection. There is agreement on the definition of potentially severe infections: meningitis, osteoarthritis, cellulitis or cellulodermitis, urinary infection, lung infection and gastroenteritis. Certain authors also include inner ear infections. In suspected cases, the need for hospitalization can be based on signs of impaired consciousness and/or muscle tone, abnormal heart rate, blood pressure or recoloration time, paleness, cyanosis, respiratory distress, signs of dehydration, or abnormal behaviour. In order to identify infants at low risk, in addition to the physical examination, the clinician can rely on essential laboratory tests: white cell count with differential count, blood culture, C-reactive protein and/or sedimentation rate with fibrinogen and an urinanalysis. A chest X-ray is required in case of respiratory signs and a culture of the fecal matter is needed in case of diarrhoea. On the basis of these findings and the clinical picture, if the criteria of low risk of bacterial infection are fulfilled in an infant under 3 months of age with fever, most authors agree that a spinal tap must nevertheless be performed. When these tests lead to the conclusion of low risk, close surveillance at home is appropriate. If the clinical picture worsens within 24h hospitalization is required. PMID:8078834

Gaudelus, J


Distribution of emm type and antibiotic susceptibility of group A streptococci causing invasive and noninvasive disease.  


To determine the prevalence of macrolide antibiotic and levofloxacin resistance in infections with Streptococcus pyogenes (group A streptococcus or GAS), strains were collected from 45 medical institutions in various parts of Japan between October 2003 and September 2006. Four hundred and eighty-two strains from patients with GAS infections were characterized genetically. Strains were classified into four groups according to the type of infection: invasive infections (n=74) including sepsis, cellulitis and toxic-shock-like syndrome; acute otitis media (AOM; n=23); abscess (n=53); and pharyngotonsillitis (n=332). Among all strains, 32 emm types were identified; emm1 was significantly more common in invasive infections (39.2 %) and AOM (43.5 %) than in abscesses (3.8 %) or pharyngotonsillitis (10.2 %). emm12 and emm4 each accounted for 23.5 % of pharyngotonsillitis cases. Susceptibility of GAS strains to eight beta-lactam agents was excellent, with MICs of 0.0005-0.063 mug ml(-1). Macrolide-resistant strains accounted for 16.2 % of all strains, while the percentages of strains possessing the resistance genes erm(A), erm(B) and mef(A) were 2.5 %, 6.2 % and 7.5 %, respectively. Although no strains with high resistance to levofloxacin were found, strains with an MIC of 2-4 mug ml(-1) (17.4 %) had amino acid substitutions at either Ser-79 or Asp-83 in ParC. These levofloxacin-intermediately resistant strains included 16 emm types, but macrolide-resistant strains were more likely than others to represent certain emm types. PMID:18927416

Wajima, Takeaki; Murayama, Somay Y; Sunaoshi, Katsuhiko; Nakayama, Eiichi; Sunakawa, Keisuke; Ubukata, Kimiko



Adverse effects of extra-articular corticosteroid injections: a systematic review  

PubMed Central

Background To estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection. Methods A systematic review of the literature was made based on a PubMed and Embase search covering the period 1956 to January 2010. Case reports were included, as were prospective and retrospective studies that reported adverse events of corticosteroid injection. All clinical trials which used extra-articular corticosteroid injections were examined. We divided the reported adverse events into major (defined as those needing intervention or not disappearing) and minor ones (transient, not requiring intervention). Results The search yielded 87 relevant studies:44 case reports, 37 prospective studies and 6 retrospective studies. The major adverse events included osteomyelitis and protothecosis; one fatal necrotizing fasciitis; cellulitis and ecchymosis; tendon ruptures; atrophy of the plantar fat was described after injecting a neuroma; and local skin effects appeared as atrophy, hypopigmentation or as skin defect. The minor adverse events effects ranged from skin rash to flushing and disturbed menstrual pattern. Increased pain or steroid flare after injection was reported in 19 studies. After extra-articular injection, the incidence of major adverse events ranged from 0-5.8% and that of minor adverse events from 0-81%. It was not feasible to pool the risk for adverse effects due to heterogeneity of study populations and difference in interventions and variance in reporting. Conclusion In this literature review it was difficult to accurately quantify the incidence of adverse effects after extra-articular corticosteroid injection. The reported adverse events were relatively mild, although one fatal reaction was reported.



Mucocutaneous lesions in transplant recipient in a tropical country.  


Dermatological manifestations are common in renal transplant patients, but differ markedly with ethnic group and geographical location. We studied mucocutaneous lesions in 54 renal allograft recipients (related donors = 30; unrelated donors = 24) living in tropical atmospheres. Their gender was 50 males, and 4 females ranging in age between 15 and 63 years (mean = 37.84 years). The mean duration of follow-up was 124 months (range = 4 to 173 months). All patients received kidneys from living donors and were kept on immunosupression with mean daily doses of prednisolone, azathioprine, and cyclosporine of 10.2 mg, 68.6 mg, and 252 mg, respectively. The mean trough concentration of cyclosporine was 185 ng/mL. The mucocutaneous lesions were divided into four groups: drug-induced (n = 24, 44.4%), fungal (n = 18, 33.3%), viral (n = 9, 16.6%), and bacterial (n = 10, 18.5%). Cushingoid features, gum hypertrophy, and hypertrichosis were seen in 7 (12.9%) patients. Steroid acne was seen in three cases. Pityriasis versicolor was the most common (20.3%) fungal infection of the skin. In addition, Tinea unguium and mucocutaneous candidiasis were noted in four and three cases respectively. Herpes virus infection (Herpes zoster 5; Herpes simplex 2) was noted in 7 (12.9%) cases. Chicken pox at 5 years posttransplant and cutaneous vasculitis associated with cytomegalovirus disease at 6 months posttransplant were seen in one case each. We have not seen warts in our patients. Pyogenic bacterial infection of skin in the form of abscess (n = 6), cellulitis (n = 3), and pyoderma (n = 1) were observed in 10 (18.5%) patients. Thus, drug-induced mucocutaneous side effects and skin fungal infections are the most common dermatological manifestations among renal transplant recipients living in a tropical country. PMID:15518786

Prakash, J; Singh, S; Prashant, G K; Kar, B; Tripathi, K; Singh, P B



Skin and Soft Tissue Infections and Associated Complications among Commercially Insured Patients Aged 0-64 Years with and without Diabetes in the U.S.  

PubMed Central

Introduction Skin and soft tissue infections (SSTIs) are common infections occurring in ambulatory and inpatient settings. The extent of complications associated with these infections by diabetes status is not well established. Methods Using a very large repository database, we examined medical and pharmacy claims of individuals aged 0–64 between 2005 and 2010 enrolled in U.S. health plans. Diabetes, SSTIs, and SSTI-associated complications were identified by ICD-9 codes. SSTIs were stratified by clinical category and setting of initial diagnosis. Results We identified 2,227,401 SSTI episodes, 10% of which occurred in diabetic individuals. Most SSTIs were initially diagnosed in ambulatory settings independent from diabetes status. Abscess/cellulitis was the more common SSTI group in diabetic and non-diabetic individuals (66% and 59%, respectively). There were differences in the frequencies of SSTI categories between diabetic and non-diabetic individuals (p<0.01). Among SSTIs diagnosed in ambulatory settings, the SSTI-associated complication rate was over five times higher in people with diabetes than in people without diabetes (4.9% vs. 0.8%, p<0.01) and SSTI-associated hospitalizations were 4.9% and 1.1% in patients with and without diabetes, respectively. Among SSTIs diagnosed in the inpatient setting, bacteremia/endocarditis/septicemia/sepsis was the most common associated complication occurring in 25% and 16% of SSTIs in patients with and without diabetes, respectively (p<0.01). Conclusions Among persons with SSTIs, we found SSTI-associated complications were five times higher and SSTI-associated hospitalizations were four times higher, in patients with diabetes compared to those without diabetes. SSTI prevention efforts in individuals with diabetes may have significant impact on morbidity and healthcare resource utilization.

Fang, Christy



Uncommon mandibular osteomyelitis in a cat caused by Nocardia africana  

PubMed Central

Background Nocardiosis is an unusual infection in companion animals characterized by suppurative to pyogranulomatous lesions, localized or disseminated. Cutaneous-subcutaneous, pulmonary and systemic signs are observed in feline nocardiosis. However, osteomyelitis is a rare clinical manifestation in cats. Nocardia cyriacigeorgica (formerly N. asteroides sensu stricto), Nocardia brasiliensis, Nocardia otitidiscaviarum, and Nocardia nova are the most common pathogenic species identified in cats, based on recent molecular classification (16S rRNA gene). The present report is, to our knowledge, the first case of mandibular osteomyelitis in a cat caused by Nocardia africana, diagnosed based upon a combination of methods, including molecular techniques. Case presentation A one-year-old non-neutered female cat, raised in a rural area, was admitted to the Companion Animal Hospital-PUCPR, São José dos Pinhais, State of Paraná, Brazil, with a history a progressive facial lesion, difficulty apprehending food, loss of appetite, apathy and emaciation. Clinical examination showed fever, submandibular lymphadenitis, and a painless, 8 cm diameter mass, which was irregularly-shaped, of firm consistency, and located in the region of the left mandible. The skin around the lesion was friable, with diffuse inflammation (cellulitis), multiple draining sinuses, and exudation of serosanguinous material containing whitish “sulfur” granules. Diagnosis was based initially in clinical signs, microbiological culture, cytological, and histopathological findings, and radiographic images. Molecular sequencing of 16S rRNA of isolate allowed diagnosis of Nocardia africana. Despite supportive care and antimicrobial therapy based on in vitro susceptibility testing the animal died. Conclusion The present report describes a rare clinical case of feline osteomyelitis caused by Nocardia africana, diagnosed based upon a combination of clinical signs, microbiological culture, cytological and histopathological findings, radiographic images, and molecular methods. The use of modern molecular techniques constitutes a quick and reliable method for Nocardia species identification, and may contribute to identification to new species of Nocardia that are virulent in cats.



Management of orbital complications due to rhinosinusitis.  


Emergencies in sinusitis are in 60-75% orbital complications defined by blepharedema (stage I), periostitis (stage II), subperiostal abscesses (SPA) (stage III) and orbital cellulites (stage IV). Ophthalmic complications such as diplopia, exophthalmia and reduced visual acuity are seen in stages III and IV. There is a consensus for primary conservative treatment in stage I or II and until recently for surgery in stages III and IV. The discussion concerns the decision for surgery versus conservative therapy in stage III in children. Another question is the definitive outcome of ophthalmic symptoms. The charts of 127 patients with orbital complications of sinusitis from 1995 until 2003 were analyzed. A follow-up questionnaire was sent to all asking for general quality of life, ophthalmic symptoms, and symptoms of sinusitis, further surgery or other treatments. The ratio of male to female was 2.3:1; 32 of the patients (25.2%) were ? 16 years and 37% had chronic rhinosinusitis. Of the adult patients, 37.9% had blepharedema, 45.3% periostitis, 4.2% SPA and 12.6% orbital cellulitis (children: 31.3, 40.6, 12.5 and 15.6%). Children with orbital cellulites were significantly (P < 0.01) older than those with SPA. Motility disorders, e.g., diplopia, were seen in 11%, exophthalmia in 12% and reduced visual acuity in 5.5%. As much as 51.2% were treated conservatively. Intervention was endoscopic sinus surgery in 81% and a combined intervention in 19%. After a mean of 40.5 months, 6 of 55 patients who had returned the questionnaire still had ophthalmic symptoms. Treatment of stages I and II are conservative, but if it fails surgery is required within 24-28 h. There is a trend for a more conservative therapy in children with stage III. However, we plead for a flexible approach to therapy in stage III and for primary surgery in patients with recurrent chronic sinusitis. PMID:20464411

Siedek, V; Kremer, A; Betz, C S; Tschiesner, U; Berghaus, A; Leunig, A



Prevalence and correlates of abscesses among a cohort of injection drug users  

PubMed Central

Recent studies have indicated that injection-related infections such as abscesses and cellulitis account for the majority of emergency room visits and acute hospitalizations accrued by local injection drug users. The objective of this analysis was to examine the prevalence and correlates of developing an abscess among a cohort of injection drug users in Vancouver and to identify socio-demographic and drug use variables associated with abscesses at baseline. We examined abscesses among participants enrolled in a prospective cohort of injection drug users. Categorical variables were analyzed using the Pearson's chi-square test and continuous variables were analyzed using the Wilcoxon signed rank test. Among 1 585 baseline participants, 341 (21.5%) reported having an abscess in the last six months. In a logistic regression model that adjusted for all variables that were associated with having an abscess at p < 0.1 in univariate analyses, female gender [odds ratio (OR) = 1.7, [95%CI: 1.2 – 2.4]; p = 0.002), recent incarceration (OR = 1.7, [95%CI: 1.3 – 2.2]; p < 0.001), sex trade involvement (OR = 1.4 [95% CI: 1.0 – 2.0]; p = 0.03), frequent cocaine use (OR = 1.5 [95%CI: 1.2 – 2.0]; p = 0.002) and HIV serostatus (OR = 1.5, [95%CI: 1.2 – 2.0]; p = 0.003) were positively associated with having an abscess. Explanations for these associations require further study, and interventions are needed to address this highly prevalent concern.

Lloyd-Smith, Elisa; Kerr, Thomas; Hogg, Robert S; Li, Kathy; Montaner, Julio SG; Wood, Evan



Clinical and laboratory findings and therapeutic responses in children with nephrotic syndrome.  


Nephrotic syndrome (NS) is a clinical entity characterized by massive loss of urinary protein leading to hypoproteinemia and edema. This prospective cross sectional study was performed on 44 children with idiopathic nephrotic syndrome (INS). The objectives were to study the clinical and biochemical parameters at the time of diagnosis of nephrotic syndrome and to study the histopathological distribution of different subtypes of INS and drug response pattern. There were 29 (66%) males and 15 females (34%). The mean age of NS was 4.87±3.24 years. Facial edema was found in 42 (95%), microscopic hematuria in 10 (23%), gross hematuria in 2 (4.5%), and hypertension in 5 (11.2%) of patients. In 17 children who underwent biopsy, focal segmental glomerulosclerosis was the most common pathologic finding (41%). Other subtypes included minimal change in three (18%), membranoproliferative glomerulonephritis in 1(5.8%), diffuse proliferative glomerulonephritis in 2 (11.6%), membranous glomerulonephritis in 1 (5.8%), and diffuse mesangial proliferation in 3 (17.5%) of cases. At the time of hospital admission, peritonitis were present in five (11.4%), pneumonia and upper respiratory infection (sinusitis) in eight (18%), cellulitis in two (4.5%). Among 44 children with NS, 29 (66%) were steroid sensitive cases, nine (20.5%) were steroid resistant and six (13.5%) were steroid dependent. Among patients with steroid sensitive NS, 37% were without relapsers, 38.8% frequent relapsers and 26.4% were infrequent relapsers. These results suggest that there are differences between season of incidence, response to treatment with corticosteroid and pathologic findings in our study and other studies in Iran and other countries. PMID:20835318

Safaei, A A S L; Maleknejad, S



Lethal outbreak of disease associated with feline calicivirus infection in cats.  


Recently, in the USA, virulent mutants of feline calicivirus (FCV) have been identified as the cause of a severe and acute virulent systemic disease, characterised by jaundice, oedema and high mortality in groups of cats. This severe manifestation of FCV disease has so far only been reported in the USA. However, in 2003, an outbreak of disease affected a household of four adult cats and an adult cat from a neighbouring household in the UK. Three of the adult cats in the household and the neighbouring cat developed clinical signs including pyrexia (39.5 to 40.5 degrees C), lameness, voice loss, inappetence and jaundice. One cat was euthanased in extremis, two died and one recovered. A postmortem examination of one of the cats revealed focal cellulitis around the right hock and right elbow joints. The principal finding of histopathological examinations of selected organs from two of the cats was disseminated hepatocellular necrosis with mild inflammatory infiltration. Immunohistology identified FCV antigen in parenchymal and Kupffer cells in the liver of both animals and in alveolar macrophages of one of them. In addition, calicivirus-like particles were observed by electron microscopy within the hepatocytes of one cat. FCV was isolated from two of the dead cats and from the two surviving cats. Sequence analysis showed that they were all infected with the same strain of virus, but that it was different from strains of FCV associated with the virulent systemic disease in cats in the USA. The outbreak was successfully controlled by quarantine in the owner's house. PMID:16632527

Coyne, K P; Jones, B R D; Kipar, A; Chantrey, J; Porter, C J; Barber, P J; Dawson, S; Gaskell, R M; Radford, A D



Complications in tissue expander breast reconstruction: a comparison of AlloDerm, DermaMatrix, and FlexHD acellular inferior pole dermal slings.  


Acellular dermal matrix (ADM) is frequently used in tissue expander breast reconstruction (TEBR) for coverage of the inferior pole. Several published studies have suggested increased rates of complications with the use of ADM. It is unknown, however, if the type of ADM used for TEBR impacts complication rates. The aim of this study is to compare 3 different types of ADM for TEBR in regard to clinically significant complications, specifically infection. We performed a retrospective analysis of primary breast cancer-related TEBR with or without ADM. Exclusion criteria consisted of prior major breast surgery, inadequate data, or loss to follow-up. Reconstructions were grouped by dermal sling type, AlloDerm, DermaMatrix (DM), FlexHD (FHD), or no ADM. Complications included cellulitis, abscess, seroma, expander leak or puncture, skin necrosis, wound dehiscence, or hematoma. Those requiring admission to hospital or reoperation were considered significant. Of 284 breasts reconstructed, 49 used AlloDerm, 110 used DM, 62 used FHD, and 64 used no ADM. The total complication rate with AlloDerm was 22% [95% confidence interval (CI), 11-34], with DM was 15% (95% CI, 8-21), and with FHD was 18% (95% CI, 8-28) (P=0.47). Infectious complication rates for AlloDerm, DM, and FHD were equal at 10% (P=0.97). The total complication rate of all ADM reconstructions as a grouped cohort was 17% compared to 11% without ADM (P=0.48). The overall incidence of infectious complications with ADM was 10% compared to 2% without ADM (P=0.09). There is no difference in the clinically significant overall complication rate or incidence of infection between AlloDerm, DM, and FHD. Isolating infectious complications, there is a trend toward increased incidence with ADM compared to reconstructions without. PMID:22868313

Brooke, Sebastian; Mesa, John; Uluer, Mehmet; Michelotti, Brett; Moyer, Kurtis; Neves, Rogerio I; Mackay, Donald; Potochny, John



Outpatient lipoabdominoplasty: review of the literature and practical considerations for safe practice.  


Background: Lipoabdominoplasty, popularized by Saldanha et al in 2001, is a powerful technique to contour the abdomen and flanks. It has not gained widespread use as concerns exist about increased complications related to wound healing and thromboembolism. Objectives: The authors review the existing literature on lipoabdominoplasty and discuss their experiences with the technique in a retrospective case series. Methods: A literature search of PubMed/MEDLINE using the search terms lipoabdominoplasty and abdominoplasty was performed by 2 independent investigators. The charts of 85 consecutive patients who underwent lipoabdominoplasty between February 2007 and July 2012 were reviewed. Results: A combined 1316 lipoabdominoplasty patients had results reported in the literature. Of these patients, 21 of 1316 (1.6%) developed seroma, 5 of 1032 (0.5%) experienced hematoma, 6 of 1032 (0.6%) experienced venous thromboembolism, and 3 of 1032 (0.3%) developed pulmonary embolism. In our case series, all patients were women with an average age of 48 years (range, 27-70 years), average body mass index of 25.2 (17.7-35.5), average follow-up of 8 months (range, 1-54 months), average lipoaspirate of 1605 mL (range, 150-5350 mL), and average weight of resected tissue of 1039 g (range, 128-4838 g). The average operative time was 225 minutes (range, 88-435 minutes), and average time in recovery prior to discharge was 124 minutes (range, 33-270 minutes). Seroma occurred in 20 of 85 patients, 1 patient developed deep venous thrombosis (DVT), 1 patient developed cellulitis, and 1 patient developed an abscess. Conclusion: Lipoabdominoplasty is a safe and effective procedure in appropriately selected patients. Performing the procedure in an outpatient setting requires attention to multiple factors in the perioperative period to ensure safe patient outcomes. Larger prospective studies should be performed to evaluate best practices regarding rare complications such as DVT or pulmonary embolism. Level of Evidence: 4. PMID:24081696

Levesque, Andre Y; Daniels, Mark A; Polynice, Alain



Sur la reponse en frequence du tissu nerveux dans le cortex  

NASA Astrophysics Data System (ADS)

Dans cette These de Physique, nous avons etudie la dependance en frequence du champ electrique du tissu nerveux dans le cortex. Ce champ est aussi designe par "Local field Potential" LFP dans la litterature scientifique. Cette etude est fondee sur la theorie du champ electromagnetisme de Maxwell et sur de l'information tiree de la donne experimentale. Le resultat essentiel de cette These est que la grandeur enorme du temps de relaxation de Maxwell des membranes cellulaires semble etre la cause principale de la dependance en frequence des LFPs. Cette dependance en frequence causee par chaque membrane cellulaire est l'analogue d'un circuit RC ou la resistance R est la resistivite parallele d'une membrane cellulaire, et ou la capacite C est la permittivite electrique de la membrane. L'effet resultant d'un tres grand nombre de cellules donne un spectre de Fourier dont l'enveloppe est tres pres d'un signal en 1/f. Le modele physique propose dans cette These permet de lier les mesures prises a l'interieur d'une dendrite des variations de potentiel electrique a celles prises dans le liquide extracellulaire. De plus, cette These semble ouvrir la possibilite de mesurer le temps de relaxation de Maxwell des membranes cellulaires a l'aide de la mesure de la reponse en frequence du potentiel electrique extracellulaire (LFP). Enfin, cette These permet de lever le voile sur un sujet peu etudie, principalement en raison de la difficulte que represente l'etude des phenomenes electriques dans des milieux complexes comme les tissus vivants. En particulier, le probleme du filtrage frequentiel du potentiel electrique extracellulaire est une propriete fondamentale du tissu nerveux et son origine n'est pas connue.

Bedard, Claude


Lattice of Passages Connecting Membranes  

NASA Astrophysics Data System (ADS)

Lattices of passages connecting membranes are frequently observed in a variety of membranous systems. We study their elastic properties within the framework of the curvature energy. Our calculations apply to the vesicle case where the constraints of constant surface and volume determine the shape profile. We concentrate on the physically relevant case of periodic boundary conditions for each cell containing passages, where the lattice parameter is set by the Gaussian bending modulus. It is shown that lattices of passages lack in-plane shear rigidity and we propose this as the basic reason for the strong fluctuations which are observed in experiments. Other compression modes couple to the vesicle shape. Our calculations are based on a detailed analysis of the shape equation. Using the Abrikosov vortex solution we show the analogies between lattices of passages and topological defects. Les réseaux de passages sont fréquemment observés dans les systèmes de membranes. Nous étudions leurs propriétés élastiques dans le cadre d'une énergie de courbure. Nos calculs s'appliquent aux cas des vésicules pour lesquelles les contraintes de surface et de volume déterminent la forme d'équilibre. Nous nous limitons aux conditions aux frontières périodiques pour chaque cellule qui sont physiquement pertinentes et dont le paramètre de réseau dépend du module de courbure Gaussien. Nous montrons que ces réseaux ne possèdent pas de constante élastique de cisaillement et nous proposons que ceci soit à l'origine des fortes fluctuations observées dans les expériences. Les autres modes sont couplés à la forme déquilibre. Nos calculs font appel à une analyse détaillée des équations de la forme de la vésicule. Utilisant la solution d'Abrikosov pour le réseau de vortex, nous montrons les analogies entre les réseaux de passages et les défauts topologiques.

Charitat, T.; Fourcade, B.



Clinical and microbiologic characteristics of invasive Streptococcus pyogenes infections in north and south India.  


The lack of epidemiologic data on invasive Streptococcus pyogenes infections in many developing countries is concerning, as S. pyogenes infections are commonly endemic in these areas. Here we present the results of the first prospective surveillance study of invasive Streptococcus pyogenes infections in India. Fifty-four patients with invasive S. pyogenes infections were prospectively enrolled at two study sites, one in the north and one in the south of India. Sterile-site isolates were collected, and clinical information was documented using a standardized questionnaire. Available acute-phase sera were tested for their ability to inhibit superantigens produced by the patient's own isolate using a cell-based neutralizing assay. The most common clinical presentations were bacteremia without focus (30%), pneumonia (28%), and cellulitis (17%). Only two cases of streptococcal toxic shock syndrome and no cases of necrotizing fasciitis were identified. Characterization of the isolates revealed great heterogeneity, with 32 different emm subtypes and 29 different superantigen gene profiles being represented among the 49 sterile-site isolates. Analyses of acute-phase sera showed that only 20% of the cases in the north cohort had superantigen-neutralizing activity in their sera, whereas 50% of the cases from the south site had neutralizing activity. The results demonstrate that there are important differences in both clinical presentation and strain characteristics between invasive S. pyogenes infections in India and invasive S. pyogenes infections in Western countries. The findings underscore the importance of epidemiologic studies on streptococcal infections in India and have direct implications for current vaccine developments. PMID:22357508

Haggar, Axana; Nerlich, Andreas; Kumar, Rajesh; Abraham, Vinod J; Brahmadathan, Kootallur N; Ray, Pallab; Dhanda, Vanita; Joshua, John Melbin Jose; Mehra, Narinder; Bergmann, Rene; Chhatwal, G Singh; Norrby-Teglund, Anna



Infectious Complications Leading to Explantation in Implant-Based Breast Reconstruction With AlloDerm.  


Objective: The role for acellular dermal matrix in implant-based breast reconstruction-providing coverage of the inferolateral border of the underlying prosthesis and allowing control over the inframammary fold-has become increasingly popular. Although AlloDerm (LifeCell, Branchburg, NJ) is free of cellular components responsible for the antigenic response, its processing does not guarantee sterility. In this study, we examine the infectious complications in tissue expander/implant-based reconstruction with AlloDerm. Methods: A retrospective cohort analysis was completed on 321 implant-based breast reconstructions over a 10-year period (1998-2008) at an academic institution. Of these cases, 75 reconstructions used AlloDerm and 246 reconstructions did not. The incidence of infections that required readmission for intravenous (IV) antibiotics and explantation was determined. Prosthetic explants due to hematoma or patient dissatisfaction were excluded from analysis. Results: There were no differences in rates of readmission for IV antibiotics (2.8% vs 5.3%; P = .291). The rate of explantation due to infected fluid collections and extrusion was higher in the AlloDerm group (8.0%, n = 6) than that in the control group (1.6%, n = 4). This result was statistically significant (P = .013). Conclusion: In this study, the rates of IV antibiotic administration for the treatment of cellulitis in implant-based breast reconstructions did not differ because of the presence of AlloDerm; however, the rate of explantation was statistically higher in reconstructions using AlloDerm. This technique has great potential in breast reconstruction, especially for single-staged implant-based reconstruction, but careful counseling of patients with regard to the higher risk of explantation is necessary. PMID:20628580

Nguyen, Minh-Doan; Chen, Chen; Colako?lu, Salih; Morris, Donald J; Tobias, Adam M; Lee, Bernard T



Infectious Complications Leading to Explantation in Implant-Based Breast Reconstruction With AlloDerm  

PubMed Central

Objective: The role for acellular dermal matrix in implant-based breast reconstruction—providing coverage of the inferolateral border of the underlying prosthesis and allowing control over the inframammary fold—has become increasingly popular. Although AlloDerm (LifeCell, Branchburg, NJ) is free of cellular components responsible for the antigenic response, its processing does not guarantee sterility. In this study, we examine the infectious complications in tissue expander/implant-based reconstruction with AlloDerm. Methods: A retrospective cohort analysis was completed on 321 implant-based breast reconstructions over a 10-year period (1998–2008) at an academic institution. Of these cases, 75 reconstructions used AlloDerm and 246 reconstructions did not. The incidence of infections that required readmission for intravenous (IV) antibiotics and explantation was determined. Prosthetic explants due to hematoma or patient dissatisfaction were excluded from analysis. Results: There were no differences in rates of readmission for IV antibiotics (2.8% vs 5.3%; P = .291). The rate of explantation due to infected fluid collections and extrusion was higher in the AlloDerm group (8.0%, n = 6) than that in the control group (1.6%, n = 4). This result was statistically significant (P = .013). Conclusion: In this study, the rates of IV antibiotic administration for the treatment of cellulitis in implant-based breast reconstructions did not differ because of the presence of AlloDerm; however, the rate of explantation was statistically higher in reconstructions using AlloDerm. This technique has great potential in breast reconstruction, especially for single-staged implant-based reconstruction, but careful counseling of patients with regard to the higher risk of explantation is necessary.

Nguyen, Minh-Doan; Chen, Chen; Colakoglu, Salih; Morris, Donald J.; Tobias, Adam M.; Lee, Bernard T.



Dispersal of Group A Streptococcal Biofilms by the Cysteine Protease SpeB Leads to Increased Disease Severity in a Murine Model  

PubMed Central

Group A Streptococcus (GAS) is a Gram-positive human pathogen best known for causing pharyngeal and mild skin infections. However, in the 1980's there was an increase in severe GAS infections including cellulitis and deeper tissue infections like necrotizing fasciitis. Particularly striking about this elevation in the incidence of severe disease was that those most often affected were previously healthy individuals. Several groups have shown that changes in gene content or regulation, as with proteases, may contribute to severe disease; yet strains harboring these proteases continue to cause mild disease as well. We and others have shown that group A streptococci (MGAS5005) reside within biofilms both in vitro and in vivo. That is to say that the organism colonizes a host surface and forms a 3-dimensional community encased in a protective matrix of extracellular protein, DNA and polysaccharide(s). However, the mechanism of assembly or dispersal of these structures is unclear, as is the relationship of these structures to disease outcome. Recently we reported that allelic replacement of the streptococcal regulator srv resulted in constitutive production of the streptococcal cysteine protease SpeB. We further showed that the constitutive production of SpeB significantly decreased MGAS5005?srv biofilm formation in vitro. Here we show that mice infected with MGAS5005?srv had significantly larger lesion development than wild-type infected animals. Histopathology, Gram-staining and immunofluorescence link the increased lesion development with lack of disease containment, lack of biofilm formation, and readily detectable levels of SpeB in the tissue. Treatment of MGAS5005?srv infected lesions with a chemical inhibitor of SpeB significantly reduced lesion formation and disease spread to wild-type levels. Furthermore, inactivation of speB in the MGAS5005?srv background reduced lesion formation to wild-type levels. Taken together, these data suggest a mechanism by which GAS disease may transition from mild to severe through the Srv mediated dispersal of GAS biofilms.

Connolly, Kristie L.; Roberts, Amity L.; Holder, Robert C.; Reid, Sean D.



Report of wood decay fungus Inonotus tropicalis (phylum Basidiomycota) from a dog with a granulomatous mediastinal mass.  


A 75.9-kg, 3.5-year-old male Irish Wolfhound dog with a 2-3-week history of gagging and eating difficulties was referred to the University of Florida Veterinary Medical Hospital (Gainesville, Florida) for evaluation of a large cranial mediastinal mass suspected to be a thymoma or lymphosarcoma. The patient had 4 months of nearly 10 kg progressive weight loss with severe flank sensitivity and radiographically apparent lumbar vertebral changes interpreted as discospondylitis. Lab work revealed hyperglobulinemia, mild proteinuria, normal T4, negative Brucella canis titer, and negative blood and urine bacterial cultures. A thoracotomy revealed a nonresectable, destructive, space-occupying mediastinal mass resulting in euthanasia without surgical recovery. Biopsies from the mass were collected during surgery for histology. Microscopic examination revealed extensive granulomatous cellulitis and lymphadenitis characterized by central cavitated necrotic areas containing debris and degenerate neutrophils, intermediate zones of fibrovascular proliferation with marked mixed inflammation, peripheral fibrosis, frequent multinucleated macrophages, and scattered mineralization. The necrotic material contained dense mats of 2 µm wide by 8-15 µm long fungal hyphae with parallel walls, acute angle branching, frequent septae, and occasional bulb-like dilations. DNA sequencing and phylogenetic analysis of the internal transcribed spacer region confirmed the presence of a fungus in the Inonotus tropicalis group. Inonotus tropicalis is primarily a wood decay fungus that is found on dead wood from angiosperms in tropical and subtropical habitats. Isolates of the I. tropicalis group have been detected a few times from immunosuppressed human beings with X-linked granulomatous disease. PMID:23929678

Sheppard, Barbara J; McGrath, Elizabeth; Giuffrida, Michelle; Craft, Serena L M; Kung, Chung Yee; Smith, Matthew E



Phase II Study of Bevacizumab in Patients With HIV-Associated Kaposi's Sarcoma Receiving Antiretroviral Therapy  

PubMed Central

Purpose Alternatives to cytotoxic agents are desirable for patients with HIV-associated Kaposi's sarcoma (KS). Vascular endothelial growth factor-A (VEGF-A) contributes to KS pathogenesis. We evaluated the humanized anti–VEGF-A monoclonal antibody, bevacizumab, in patients with HIV-KS. Patients and Methods Patients with HIV-KS who either experienced progression while receiving highly active antiretroviral therapy (HAART) for at least 1 month or did not regress despite HAART for at least 4 months were administered bevacizumab 15 mg/kg intravenously on days 1 and 8 and then every 3 weeks. The primary objective was assessment of antitumor activity using modified AIDS Clinical Trial Group (ACTG) criteria for HIV-KS. HIV-uninfected patients were also eligible and observed separately. Results Seventeen HIV-infected patients were enrolled. Fourteen patients had been receiving effective HAART for at least 6 months (median, 1 year). Thirteen patients had advanced disease (ACTG T1), 13 patients had received prior chemotherapy for KS, and seven patients had CD4 count less than 200 cells/?L. Median number of cycles was 10 (range, 1 to 37 cycles); median follow-up was 8.3 months (range, 3 to 36 months). Of 16 assessable patients, best tumor responses observed were complete response (CR) in three patients (19%), partial response (PR) in two patients (12%), stable disease in nine patients (56%), and progressive disease in two patients (12%). Overall response rate (CR + PR) was 31% (95% CI, 11% to 58.7%). Four of five responders had received prior chemotherapy for KS. Over 202 cycles, grade 3 to 4 adverse events at least possibly attributed to therapy included hypertension (n = 7), neutropenia (n = 5), cellulitis (n = 3), and headache (n = 2). Conclusion Bevacizumab is tolerated in patients with HIV-KS and has activity in a subset of patients.

Uldrick, Thomas S.; Wyvill, Kathleen M.; Kumar, Pallavi; O'Mahony, Deirdre; Bernstein, Wendy; Aleman, Karen; Polizzotto, Mark N.; Steinberg, Seth M.; Pittaluga, Stefania; Marshall, Vickie; Whitby, Denise; Little, Richard F.; Yarchoan, Robert



High-Dose-Rate Intraoperative Radiation Therapy for Recurrent Head-and-Neck Cancer  

SciTech Connect

Purpose: To report the use of high-dose-rate intraoperative radiation therapy (HDR-IORT) for recurrent head-and-neck cancer (HNC) at a single institution. Methods and Materials: Between July 1998 and February 2007, 34 patients with recurrent HNC received 38 HDR-IORT treatments using a Harrison-Anderson-Mick applicator with Iridium-192. A single fraction (median, 15 Gy; range, 10-20 Gy) was delivered intraoperatively after surgical resection to the region considered at risk for close or positive margins. In all patients, the target region was previously treated with external beam radiation therapy (median dose, 63 Gy; range, 24-74 Gy). The 1- and 2-year estimates for in-field local progression-free survival (LPFS), locoregional progression-free survival (LRPFS), distant metastases-free survival (DMFS), and overall survival (OS) were calculated. Results: With a median follow-up for surviving patients of 23 months (range, 6-54 months), 8 patients (24%) are alive and without evidence of disease. The 1- and 2-year LPFS rates are 66% and 56%, respectively, with 13 (34%) in-field recurrences. The 1- and 2-year DMFS rates are 81% and 62%, respectively, with 10 patients (29%) developing distant failure. The 1- and 2-year OS rates are 73% and 55%, respectively, with a median time to OS of 24 months. Severe complications included cellulitis (5 patients), fistula or wound complications (3 patients), osteoradionecrosis (1 patient), and radiation-induced trigeminal neuralgia (1 patient). Conclusions: HDR-IORT has shown encouraging local control outcomes in patients with recurrent HNC with acceptable rates of treatment-related morbidity. Longer follow-up with a larger cohort of patients is needed to fully assess the benefit of this procedure.

Perry, David J.; Chan, Kelvin; Wolden, Suzanne; Zelefsky, Michael J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Chiu, Johnny; Cohen, Gilad; Zaider, Marco [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Kraus, Dennis; Shah, Jatin [Division of Head and Neck Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Lee, Nancy, E-mail: Leen2@mskcc.or [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)



Genome-wide differential gene expression profiles in broiler chickens with gangrenous dermatitis.  


Gangrenous dermatitis (GD) is a disease of poultry characterized by necrosis of the skin and severe cellulitis of the subcutaneous tis