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 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-two patients with acute acalculous cholecystitis are presented. The age of the patients ranged from 1 to 80 years, with an average of 46.3 years. Acute acalculous cholecystitis occurred during the postoperative period in only four patients. Three patients were receiving total parenteral nutrition and 16 patients had one or more associated medical diseases. One patient had acute acalculous cholecystitis due to mechanical obstruction of the cystic duct caused by a diaphragmatic hernia. The most frequent signs and symptoms were right upper quadrant abdominal pain, nausea, vomiting, fever, abdominal mass, and jaundice. All patients were subjected to cholecystectomy. Nine (28.1%) gallbladder specimens had gangrene. Pericholecystic perforation was observed in four patients (12.5%) free perforation in one patient (3.1%), and empyema of the gallbladder in one patient (3.1%). Bacteria were cultured from 18 of 24 bile specimens. E. coli was the most common organism isolated. The overall postoperative mortality and complication rates were 15.6% and 40.6% respectively. The average hospital stay was 16.4 days.
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PMID:Acute acalculous cholecystitis. 193 1

Imipenem-cilastatin was given in doses of 1 g intravenously every 6 h to 31 patients. Twenty-five patients, with 27 infections, were clinically evaluable and received 20 to 210 g of imipenem for a duration of 5 to 56 days (average 16.3 days). Infections included seven cases of osteomyelitis, seven of bacteremia, five of cellulitis, two of pneumonia, three of pelvic cellulitis, two of intraabdominal abscess, and one each of empyema, mediastinitis, and endometritis. Fifty-five percent of the infections were caused by gram-negative bacilli, 33% were due to gram-positive organisms, and 10% were caused by anaerobes. Twenty-two patients (81%) were cured, three improved, one relapsed, and one became superinfected with a resistant organism. In 5 of 11 cases with Pseudomonas aeruginosa, the imipenem MIC for organisms isolated by the end of treatment was higher than it was initially, raising concern that imipenem should not be used alone to treat Pseudomonas aeruginosa infections. Twenty-one patients had no adverse reaction; of the remaining 10 patients, 4 had nausea, 1 had urticaria, and 6 had mild abnormalities in hepatic function; three episodes of diarrhea included two with Clostridium difficile toxin in stool and one with pseudomembranous colitis, as determined by sigmoidoscopy. Levels of creatinine, hemoglobin, leukocytes, platelets, prothrombin, and urine components were unchanged. Imipenem-cilastatin is a clinically effective antibiotic with freedom from nephrotoxicity and hematological abnormalities in the large doses used in this study.
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PMID:Safety and efficacy of high-dose treatment with imipenem-cilastatin in seriously ill patients. 386 Jan 87

Twenty-one adult patients hospitalized with lower respiratory tract infections due to Branhamella catarrhalis or Haemophilus influenzae or both were treated with the combination of oral amoxicillin and potassium clavulanate (Augmentin) in an open, noncomparative clinical trial. Diseases included pneumonia, empyema, and exacerbations of bronchiectasis and chronic lung disease. Thirteen of 16 B. catarrhalis and six of nine H. influenzae isolates were beta-lactamase positive. The patients with B. catarrhalis were treated for a mean of 5.3 days, and those with H. influenzae were treated for a mean of 7.0 days. The overall response to therapy was excellent, with 18 of 19 beta-lactamase-producing strains eradicated on therapy. One patient secondarily infected with Pseudomonas aeruginosa was a clinical failure, and two patients with H. influenzae who became culture positive again after therapy were considered microbiologic failures. Gastrointestinal side effects (especially nausea) were common, although all patients completed a course of therapy. Sputum levels of amoxicillin were surprisingly low (less than 0.05 to 0.54 micrograms/ml), a finding which may explain the high relapse rate (22%) seen with H. influenzae, as these are below the usual MICs of amoxicillin for this organism. The combination of amoxicillin plus potassium clavulanate appears to be an excellent drug for treatment of beta-lactamase-producing strains of these two species, although mild gastrointestinal side effects are common.
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PMID:Amoxicillin-clavulanic acid in the treatment of lower respiratory tract infections caused by beta-lactamase-positive Haemophilus influenzae and Branhamella catarrhalis. 387 10

A case of empyema of the gallbladder in a eight year old child is reported. The child presented simptoms relatively constant in the hydrops of the gallbladder, nomely abdominal pain usually confined to the right upper quadrant and or epigastrium, fever, nausea, vomit, dehidratation; a tender abdominal mass was palpable. As usually occurs in childhood, the acute distension of the gallbladder followed in this report, to preceding focus of infection (angina and cervical lymphadenopathy). Ultrasonography permitted to address the correct diagnosis. This was later confirmed at surgery and from histopathologic study.
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PMID:[Empyema of the gallbladder in an 8-year old boy]. 639 30

Roxithromycin, a new introduction into the macrolide class of antibiotics possesses favourable pharmacokinetic properties enabling a once daily dosing. This study evaluates its efficacy, safety and tolerability, previously demonstrated in Europe and North America, in Nigeria patients suffering from lower respiratory tract infections. 32 patients, aged 18-65 years with acute bronchitis/acute exacerbation of chronic bronchitis and pneumonia were administered roxithromycin 300 mg once daily. 25 patients (12 males, 13 females: aged 39.2 +/- 2.7 years) were evaluable for clinical efficacy at the end of the study. The mean duration of treatment was 6.9 +/- 0.5 days. 22 patients (88.0%) responded to therapy. Sputum culture was positive in 5 patients (20.0%): Streptococcus pneumonia and resistant Klebsiella pneumonia. Therapy was discontinued in 3 patients due to non-response. The two patients in whom Klebsiella were isolated did not show any significant clinical improvement. The third non responding patient developed empyema. Gram negative bacilli were identified in the pleural aspirate but no patients with resistant Streptococcus pneumonia improved clinically. Adverse effects were mild, transient and included nausea (4) and diarrhoea (1). The study suggests that roxithromycin is an effective and well tolerated antibacterial in the treatment of lower respiratory tract infection.
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PMID:An open evaluation of the efficacy and safety of the new macrolide roxithromycin in the treatment of lower respiratory tract infections and pneumonia in Nigerian patients. 885 75

The study covers 232 patients with chronic calculous cholecystitis, operated in the Surgical Clinic of the Military Hospital--Plovdiv over the period 1991 through August 1995. Bilithiasis (cholenephrolithiasis) is diagnosed in 26 cases (11.2 per cent). This is a condition running a clinical course characterized by pain in the right subcostal and lumbosacral regions, accompanied by nausea and vomit in 57.7 per cent. Eighteen patient sustain renal crisis. Palpatorily, pain is established in the right subcostal region, and positive succussio renalis--in twelve patients. In nine patients there is evidence of albuminuria and leukocyturia (34.6 per cent). In 26 cases the echographic study reveals presence of concretions in the gallbladder, and in all of them-renal calculi too (left kidney--9, right kidney--9, and bilaterally--8 patients). Intraoperatively, concretions in the gallbladder are found in all patients, with hydrops and empyema of the gallbladder documented in five, and vesicoduodenal fistula in one (23 per cent), whereas in the patients free of urolithiasis they amount to 10.8 per cent which points to a reciprocal aggravation of the two pathological conditions. The early, as well as the long-term results of the operative management applied are estimated as very good.
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PMID:[Bilithiasis (cholenephrolithiasis)]. 973 78

A previously healthy man aged 18 years suddenly developed a severe headache, followed by nausea, vomiting, fever. During the following weeks a left-sided hemiparesis developed. CT of the brain revealed a pansinusitis and a frontal epidural empyema. A few days after surgical drainage his condition deteriorated and subsequent CT showed a right-sided subdural empyema. This was surgically evacuated and followed by long-term high-dose intravenous antibiotic therapy. The patient made a complete recovery. A sudden severe headache can be caused by an intracranial infection and intracranial pus collections can occur in the subdural as well as in the epidural space. Epidural empyema is a limited disease with relatively mild symptoms and a favourable prognosis, whereas subdural empyema may rapidly spread and cause severe disease with a poor prognosis. Quick antibiotic treatment and surgical drainage are required.
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PMID:[Clinical thinking and decision making in practice. A student with sudden headache]. 1092 61

This paper reviews the safety data for levofloxacin utilizing reports from clinical and post-marketing surveillance trials. The side effect incidence rates are 1.3% for nausea, 0.1% for anxiety, 0.3% for insomnia, and 0.1% for headache. No levofloxacin-related adverse events were reported at a rate higher than 1.3%, and most were lower. Four clinical trials were reported. Levofloxacin achieved superior clinical and microbiological results compared to ceftriaxone/macrolide combination, and was better tolerated. Results comparing IV azithromycin plus ceftriaxone versus 500 mg levofloxacin in hospitalised CAP demonstrated that levofloxacin performed better, with more adverse events associated with the comparators (levofloxacin 5.3%, comparators 9.3%). High-dose levofloxacin (750 mg) was also evaluated and found to be well tolerated. Surveillance data reported low ADR rates for levofloxacin: nausea 0.8%, rash 0.5%, abdominal pain 0.4%, and diarrhoea, dizziness, and vomiting 0.3%. Worldwide and US surveillance data confirmed that tendon rupture occurred in less than 4 per million prescriptions, taste perversion in less than 3 per million, convulsions in 2 per million, and photosensitivity, hepatitis, hepatic failure, QT prolongation, torsade de pointes or empyema all in less than 1 per million.
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PMID:Latest industry information on the safety profile of levofloxacin in the US. 1154 87

The incidence of congenital diaphragmatic hernia (CDH) is about 4.8/10,000 live births. Its typical clinical presentation is respiratory distress occurring immediately after birth or in the first few hours or days of a child's life. It is characterized by a high mortality rate. Exceptionally, CDH can occur at an older age, its symptoms then frequently reflecting gastrointestinal obstruction or mild respiratory symptoms. In such cases CDH presents a far more complex diagnostic problem. The paper presents the cases of two girls without typical symptomatology, aged 5.5 and 10 years, in whom CDH was detected incidentally upon thorough physical examination and chest x-rays. Further radiographic evaluation, which included barium contrast study and spiral computed tomography, confirmed the suspicion of a left-sided posterolateral diaphragmatic hernia with associated intestinal malrotation. Surgical intervention conclusively confirmed a diaphragmatic defect at the site of Bochdalek's foramen in both cases. The vital capacity of the older girl, which was low before the surgery (VC 1.66 L; 69% of predicted), was significantly increased a month after the surgical treatment (VC 2.25 L; 92% of predicted). The generally expressed view that the clinical onset of CDH is rare after the neonatal period seems to be erroneous. Some papers report on the clinical presentation of CDH after the neonatal period in as many as 13%-14% of infants and young children suffering from CDH. Infants and young children with a delayed clinical occurrence of CDH can present with respiratory or gastrointestinal symptomatology. Children presenting with gastrointestinal symptoms have been shown to be significantly older than those presenting with respiratory symptoms. In older children and adolescents, the symptoms and signs of CDH, which include acute hernial incarceration, nausea, recurrent vomiting, diarrhea, obstipation, acute gastric dilatation, subcostal pain, failure to thrive and recurrent chest infections, habitually present a significant diagnostic problem. Diagnostic errors are mainly due to the fact that the possibility of CDH in that age is totally neglected. The most recurrent diagnostic misinterpretations in such cases are pneumonia or massive pleuropneumonia, empyema, pneumothorax, lung cysts and bullae, and gastric volvulus. Thus, whenever a child presents with uncommon respiratory or gastrointestinal symptoms and an anomalous chest x-ray, a differential diagnosis of CDH should be considered. Otherwise, an accurate diagnosis in both young and older children will most probably be only reached at autopsy. In conclusion, the presented cases corroborate the finding that CDH in older children may present with scarce symptoms, mostly gastrointestinal, or may be altogether asymptomatic and unrecognized until as late as adolescence. However, when a diagnosis of CDH has been established, albeit asymptomatic, it must be promptly treated surgically in order to prevent complications, such as strangulation or bowel perforation, and thus avert a potentially fatal outcome. The size itself of the herniac foramen is unlikely to be a determining factor at the time of clinical presentation of CDH. Surgical occlusion of CDH may in older children result in an improved vital capacity, as such cases are rarely associated with major pulmonary hypoplasia. Complications resulting from surgical treatment of CDH in older children are more likely to occur in the gastrointestinal system, as a consequence of the associated bowel malrotation and inadequate bowel fixation. Finally, these two cases corroborate the diagnostic value of accurate history taking and thorough physical examination.
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PMID:[Congenital diaphragmatic hernia in older children]. 1550 87

Fusobacterium necrophorum infections are rare. We report a 15-year-old male who presented with tachycardia, nausea, vomiting, diarrhoea and ankle pain. He rapidly deteriorated requiring ventilation and vasopressors. Imaging of his thorax showed airspace consolidation, pulmonary cavitations and empyema. The ankle required drainage of purulent material. A thrombus in his internal jugular vein (Lemierre's syndrome) and an abscess in his obturator internus were subsequently found. Fusobacterium necrophorum was identified in blood culture on day nine. The patient recovered with antibiotics and surgical interventions for empyema and septic arthritis. Fusobacterium necrophorum should be a suspected pathogen in septic shock complicated by metastatic abscess formation.
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PMID:Lemierre's syndrome with septic shock caused by Fusobacterium necrophorum. 1793 73


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