RESUMO
A young man with known steroid refractory terminal ileal Crohn's disease developed torrential gastrointestinal bleeding necessitating an emergency ileal resection. Serology was indicative of primary cytomegalovirus (CMV) infection and this was confirmed with histopathology of the resected ileum. We highlight the difficulty in clinical practice of distinguishing between CMV infection and CMV disease as well as the different investigations available to aid in the diagnosis of pathogenic CMV disease.
Assuntos
Doença de Crohn/tratamento farmacológico , Infecções por Citomegalovirus/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Ileíte/diagnóstico , Esteroides/uso terapêutico , Adulto , Doença de Crohn/complicações , Doença de Crohn/cirurgia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/cirurgia , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/cirurgia , Humanos , Ileíte/complicações , Ileíte/cirurgia , MasculinoRESUMO
In immunocompromised patients, endovascular infection due to Candida albicans is associated with significant morbidity and mortality. Recommended management includes removal of any existing central venous catheter. Rarely, complications of endocarditis or infected mural thrombi may arise, with poorer clinical outcomes. For large endoluminal lesions, particularly of the great vessels or those that are intra-atrial, thrombolysis has been used in paediatric populations or before surgery for dissolution of infected thrombus. We describe the case of an adult patient with lung carcinoma who developed persisting candidaemia with a large endovascular fungal lesion adherent to the tip of a peripherally inserted central venous catheter. Local urokinase infusion enabled safe removal of the catheter without embolization. As an adjunct to antifungal therapy, local thrombolysis may play a contributory role in the management of central venous catheter-related candidal septic thrombosis.
Assuntos
Candidíase/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Fibrinolíticos/uso terapêutico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Feminino , Fungemia/complicações , Humanos , Hospedeiro Imunocomprometido , Neoplasias Pulmonares/complicações , Pessoa de Meia-IdadeRESUMO
Objectives of this study were to analyze work functions in a vegetable pre-preparation unit of a large residence hall foodservice using occurrence sampling and to determine cleaning times for selected vegetables. Data were collected in the early spring for 14 consecutive days. Total hours worked were 349.5; 2,174 observations were recorded. Percentage labor time and minutes expended were calculated for cleaning selected vegetables. Average cleaning times were established for minutes per pound and purchase unit for carrots, celery, head lettuce, leaf lettuce, yellow onions, and red and white potatoes.