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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Flushing of the skin of an infant may be a sign of the child's first allergic reaction to food, insect envenomation, or other allergens, a sign of sepsis, or due to dilation of cutaneous vessels caused by a vasodilator substance or neural mechanisms. A rare cause of this condition results in the release of mast cell mediators such as histamine, prostaglandin D2, tryptase, chymase, and leukotrienes. We present a case of a 6-month-old with severe total body flushing and a yellow-tan, raised, well-demarcated lesion on the thigh consistent with a solitary mastocytoma. Erythema was most pronounced adjacent to the lesion, suggesting a positive Darier sign. Subsequent evaluation by a dermatologist confirmed the diagnosis, and the patient underwent no further therapy; however, the family was appropriately counseled on management if the symptoms were to reappear. Appropriate diagnosis and management of this patient and other forms of mastocytosis in children are discussed.
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PMID:A 6-month old with total body flushing and a macular-papular lesion. 1750 76

Peripherally Inserted Central Catheters (PICC) represent an alternative for critical patient care, and are safer to implant in home patients. The authors report on their experience with the first 200 4 Fr Groshong PICC implanted during the last 18 months. The procedure can be easily applied at home (98% successful implant rate), without the need for fluoroscopic or ultrasound guidance. Moreover, the authors believe that the X-ray control after implant is not strictly necessary. After 11,570 days/catheters, only 5 devices were explanted because of complications: 4 because of sepsis and peripheral phlebitis, and the last was explanted by another medical staff for unclear reasons. The complications needing no explanation were a total of 32: for 12 of them the external portion of tube was damaged during use, while for the other 20 the internal clots were resolved with forced flushing. The authors conclude that Groshong PICC can be considered the gold standard for home care management of critical patients, taking into account the quality of pure silicon, the presence of a valve and the specially-made closed-tip.
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PMID:Groshong PICC and home care: an opportunity. Clinical experience after the first 200 implants. 1763 36

Threats of nuclear and other radiologic exposures have been increasing, but no countermeasure for acute radiation syndrome has been approved by regulatory authorities. Because of their similarity to humans in regard to physiology and anatomy, we are characterizing Gottingen minipigs as a model to aid the development of radiation countermeasures. Irradiated minipigs exhibit immunosuppression, severe thrombocytopenia, vascular leakage, and acute inflammation. These complications render serial acquisition of blood samples problematic. Vascular access ports (VAP) facilitate serial sampling, but their use often is complicated by infections and fibrin deposition. We demonstrate here the successful use of VAP for multiple blood samplings in irradiated minipigs. Device design and limited postoperative prophylactic antimicrobial therapy before irradiation were key to obtaining serial sampling, reducing swelling, and eliminating infection and skin necrosis at the implantation site. Modifications of previous protocols included the use of polydioxanone sutures instead of silk; eliminating chronic port access; single-use, sterile, antireflux prefilled syringes for flushing; strict aseptic weekly maintenance of the device, and acclimating animals to reduce stress. VAP remained functional in 19 of 20 irradiated animals for as long as 3 mo. The remaining VAP failed due to a small leak in the catheter, leading to clot formation. VAP-related sepsis occurred in 2 minipigs. Blood sampling did not cause detectable stress in nonanesthetized sham-irradiated animals, according to leukograms and clinical signs.
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PMID:Vascular access port implantation and serial blood sampling in a Gottingen minipig (Sus scrofa domestica) model of acute radiation injury. 2133 66

Management of a resilient diverticular abscess poses a big challenge. Currently there are no guidelines for the number of percutaneous drainages to be performed in resilient diverticular abscesses before attempting surgery. All patients (n = 117) who presented with a computed tomography scan-proven diverticular abscess from July 2008 to June 2011 were studied. They were divided into four groups based on the number of percutaneous drainages they underwent for their diverticular abscess: six patients underwent three or more drainages, nine patients underwent two drainages, 27 patients had one drainage, and 75 patients had no drainage. Readjustment, flushing, and upgrading size of the drain were not considered as separate drainage procedures. The size of abscess cavity was significantly higher for the patients who had three or more drainages (mean 8 cm, P < 0.001). A Hartmann's procedure was performed in the majority of patients in the three or more drainage group (83%) but in decreasing frequency as the number of drainages performed dropped: two drainage group (44%), one drainage group (15%), and no drainage group (19%). There was a significantly higher preoperative hospital stay for drainage and antibiotics in the patients from the three or more drainage group (P < 0.001). Patients with a resilient diverticular abscess are very likely to undergo a Hartmann's procedure after two attempted drainages. By performing additional percutaneous drainages in an attempt to avoid ostomy, patients are at an increased risk of sepsis and peritonitis with prolonged antibiotics and increased healthcare costs. We recommend limiting percutaneous drainage procedures to two attempts to cool down a resilient diverticular abscess before definitive surgery.
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PMID:Percutaneous drainage of a diverticular abscess should be limited to two attempts for a resilient diverticular abscess. 2498 92

Although previous evidence suggests advantages of nifedipine over terbutaline as tocolytic agents, in some jurisdictions, terbutaline is approved for use and nifedipine is not. In women in preterm labour, we compared the impact of terbutaline versus nifedipine on inhibition of uterine contractions, preterm birth, neonatal sepsis, intracranial haemorrhage or necrotizing enterocolitis, death or admission to a neonatal intensive care unit and maternal adverse reactions. We randomized 32 women to nifedipine and 34 to terbutaline. We found no difference between groups in tocolysis or preterm birth. No serious maternal adverse effects or serious neonatal adverse outcome occurred in either group. Less serious maternal adverse effects less common with terbutaline included flushing (2.94% versus 43.7%) and headache (5.9% versus 31.2%). The administration of terbutaline increased tremor (76.4% versus 0%), nausea (58.8% versus 9.4%) and dizziness (29.4% versus 6.25%). The total number of side effects, and the proportion of women experiencing one or more side effects, proved greater with terbutaline. In this study, terbutaline and nifedipine performed similarly in their tocolytic effects. Each drug has specific side effects, although overall, nifedipine was associated with fewer adverse effects.
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PMID:Nifedipine versus terbutaline, tocolytic effectiveness and maternal and neonatal adverse effects: a randomized, controlled pilot trial. 2514 33

We report a patient with AIDS who had an anaphylactic-like reaction from trimethoprim-sulfamethoxazole. Clinical suspicion of anaphylaxis should be considered in patients presenting with fever, hypotension, eosinophilia, rash, flushing or pulmonary infiltrates after initial exposure and re-exposure to the medication. This case highlights the need for healthcare professionals to be reminded of the association between this unusual antibiotic reaction resembling sepsis and HIV disease.
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PMID:Anaphylactic-like reaction from trimethoprim-sulfamethoxazole in a patient with AIDS. 2599 69

Raoultella ornithinolytica is a species of gram-negative encapsulated and aerobic bacteria belonging to the family Enterobacteriaceae and is mainly found in fish. The most distinctive feature of this bacterium is the ability to convert histidine to histamine; therefore, the consumption of decomposing fish infected by R. ornithinolytica causes rashes, diarrhea, flushing, sweating and vomiting. This food poisoning is also called histamine fish poisoning; however, human infections with R. ornithinolytica are extremely rare and have so far only affected patients with diseases suppressing the immune system. The current case report describes for the first time sepsis with evidence of bloodstream infection by R. ornithinolytica in an immunocompetent male patient and the successful antibiotic treatment.
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PMID:[Sepsis caused by Raoultella ornithinolytica in an immunocompetent patient]. 2681 48

We report our clinic experience with central venous catheters (CVCs) in 23 children with haemophilia, who, in total, had 35 catheters. Seventeen of the 23 children had Broviac catheters (external), 6/23 had an implantable device (Port-A-Cath) only, while four had Broviac and Port-A-Cath at different times. The age of the patients at the time of initial catheter placement ranged from 4 months to 18 years; 11 were under age 3 years. Indications for CVC placement included induction of immune tolerance, treatment of HIV-related complications, prophylactic therapy following intracranial haemorrhage, primary prophylaxis and secondary prophylaxis. Catheter-related infection was the most common complication, occurring in 84% of the external catheters. Of these infections 79% occurred in HIV-negative subjects. Staph and strep species were the most common infectious organisms isolated. Minor bleeding around the catheter occurred in 20% of cases even with adequate correction of haemophilia. Three children accidentally removed the external catheter (12%). Thrombosis of the catheter was uncommon (8%), occurring in only two patients, one of whom had a small newborn size external catheter. When presenting with line sepsis, haemophilic children who were HIV negative had transient temperature spikes approximately 1 h after catheter flushing. This presentation was different from our oncology or HIV-positive patients with CVC-related sepsis. Our experience with ports (Port-A-Cath) in haemophilic children is limited, but catheter-related infection (40%) seems to be less of a problem with the implantable device and the ports have been well accepted by our haemophilic patients and their parents.
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PMID:Use of central venous catheters in children with haemophilia: one haemophilia treatment centre experience. 2721 4

Raoultella ornithinolytica is increasingly being isolated as a causative organism in human infections. Most of the infections caused by R. ornithinolytica are hospital acquired and occur in patients who are immunocompromised, had invasive procedures or have indwelling catheters. This is a first report of early onset neonatal sepsis caused by multi-drug-resistant R. ornithinolytica. The infection was not very severe and was characterised by generalized flushing of the skin. Patient made complete recovery once appropriate antibiotics were started.
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PMID:First report of neonatal early-onset sepsis caused by multi-drug-resistant Raoultella ornithinolytica. 2910 80

Delayed bowel erosion by peritoneal dialysis catheter is rare with fewer than thirty cases having been reported in the literature. This complication is usually encountered when the catheter is kept dormant. Two cases have also been reported with catheters in active use. The risk factors for bowel erosion include immunosuppression, diverticulosis, and amyloidosis. An 80-year-old male with chronic kidney disease Stage 5 due to hypertensive nephrosclerosis underwent chronic ambulatory peritoneal dialysis catheter insertion. Due to improvement in the glomerular filtration rate and clinical parameters including extracellular fluid volume status, peritoneal dialysis was not initiated. Weekly catheter flushes were performed. After 5 months, he developed watery diarrhea after a regular flushing episode. Computed tomography scan revealed the catheter displaced into the sigmoid colon with the tip in the rectum. He was managed successfully with catheter removal alone and conservative treatment. He remains asymptomatic at 3-month follow-up. This case is presented to emphasize the fact that delayed bowel erosion can happen with dormant catheter even in the absence of risk factors. Periodic flushing has not prevented this complication in our patient. Perforations can be self-curing when diagnosed early and when patients present without features of peritonitis or sepsis. Such cases can be managed successfully with catheter removal alone.
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PMID:Bowel Migration of Dormant Chronic Ambulatory Peritoneal Dialysis Catheter: A Vexed Problem Not Avoided by Flushing. 2921 92


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