RESUMEN
There has recently been an outbreak of injectional anthrax infection secondary to contaminated heroin use in the UK and Europe. We present a case of a 37-year-old man presenting with pain and swelling in the groin following injection of heroin into the area. He was initially treated for severe cellulitis, however, he failed to respond to appropriate antimicrobial therapy. He went onto develop a widespread rash; it was then that a diagnosis of injectional anthrax infection was considered. Appropriate investigations were initiated including serum sample and tissue biopsy, and the diagnosis was confirmed. Management included extensive surgical debridement and a prolonged course of combination antibiotic therapy. The authors summarise the important steps in diagnosis and the management options in patients presenting with this life-threatening infection.
Asunto(s)
Carbunco/terapia , Bacillus anthracis , Contaminación de Medicamentos , Infecciones de los Tejidos Blandos/microbiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Carbunco/microbiología , Heroína , Humanos , Drogas Ilícitas , Masculino , Infecciones de los Tejidos Blandos/terapia , Abuso de Sustancias por Vía Intravenosa/microbiologíaRESUMEN
BACKGROUND/PURPOSE: Total esophagogastric dissociation has been described as both a primary and a rescue procedure for patients with severe gastroesophageal reflux. Although most commonly used in the neurologically impaired, it has also been used in those with no neurological impairment. The main objective of this study was to determine morbidity and mortality for this procedure. METHODS: All published cases of esophagogastric dissociation in children were identified. Series were updated where possible by personal communication with the author. Patient characteristics, indications, morbidity, and mortality were analyzed. RESULTS: One hundred eighty-one cases were identified. One hundred seventeen were primary operations and 64 were rescue procedures. There were 29 (16.0%) early complications and 28 (15.5%) late complications with 6 (3.3%) deaths related to the procedure of a total of 35 deaths. Twenty-one patients (11.6%) required re-operation in the study periods. CONCLUSIONS: Esophagogastric dissociation has an acceptable morbidity and mortality. It is useful as both a primary and a rescue procedure.