RESUMO
We report a case of a 60-year-old Caucasian man with a history of alcohol excess who presented to the emergency department with a 72-hour history of abdominal pain, profuse diarrhoea and vomiting. He was admitted to the intensive care unit (ICU) 12 hours later in extremis with severe sepsis and multiorgan failure. Collateral history from the patient on admission to ICU identified that he had been bitten by a dog 3 days prior to his symptom onset. Provisional microscopy and Gram staining from peripheral blood cultures taken on admission revealed the presence of long, thin Gram-negative bacilli in the anaerobic bottle only. This was later identified as Capnocytophaga canimorsus The patient survived the septic episode and was discharged to level 2 care 9 days later under the care of the renal physicians for ongoing renal dialysis.
Assuntos
Mordeduras e Picadas/complicações , Capnocytophaga/isolamento & purificação , Cães , Gastroenterite/microbiologia , Infecções por Bactérias Gram-Negativas/etiologia , Sepse/microbiologia , Dor Abdominal/microbiologia , Animais , Mordeduras e Picadas/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/microbiologia , Náusea/microbiologia , Vômito/microbiologiaRESUMO
BACKGROUND: Post surgical quality of life (QOL) plays an important role in the decision making process for patients. This study evaluated the subjective opinion of those that underwent Nissen fundoplication to correct their symptoms of hiatus hernia. This study was to evaluate the quality of life and symptomatology before and after in those patients that underwent Nissen fundoplication over an 8-year period. METHODS: A questionnaire that graded the severity of symptoms and quality of life pre- and post-operatively was sent out to those patients that had undergone Nissen fundoplication. RESULTS: After the operation the symptoms of heartburn, regurgitation, burping and difficulty lying down were markedly decreased (P < 0.0001). There was however an increased incidence of flatulence associated with the procedure (P < 0.0001). Despite this the quality of life was significantly increased in those that underwent Nissen fundoplication (P < 0.0001). CONCLUSIONS: Nissen Fundoplication has a positive impact on quality of life and is effective in reducing symptoms of heartburn, regurgitation, burping and difficulty lying down associated with a hiatus hernia. There is however an increase in the incidence of flatulence associated with the procedure. In spite of this, 94% of patients would recommend the procedure to someone else.