RESUMO
A 69-year-old man developed Propionibacterium acnes left knee hardware infection after suffering from an infected ingrown toenail. The hardware was removed and he was treated with intravenous vancomycin. Ten days after initiation of vancomycin, he developed severe thrombocytopaenia, epistaxis and petechiae. Vancomycin was discontinued, and platelets rapidly recovered. Serum vancomycin IgG were positive. Patient completed a 6-week course of ceftriaxone with no further complications.
Assuntos
Antibacterianos/efeitos adversos , Artroplastia do Joelho , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Doenças da Unha/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Trombocitopenia/induzido quimicamente , Vancomicina/efeitos adversos , Idoso , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Epistaxe/induzido quimicamente , Humanos , Masculino , Doenças da Unha/microbiologia , Doenças da Unha/cirurgia , Unhas/microbiologia , Contagem de Plaquetas , Complicações Pós-Operatórias/microbiologia , Propionibacterium acnes/isolamento & purificação , Resultado do Tratamento , Vancomicina/uso terapêuticoRESUMO
Endemic fungal infections can present atypically and should be considered in the differential diagnosis of any soft tissue infection not responding appropriately to antibiotic therapy. Diagnosis can be confirmed with a biopsy. Most fungal soft tissue infections require extended duration of treatment.
Assuntos
Epidemias/prevenção & controle , Armas de Fogo , Assistência Perioperatória/métodos , Papel do Médico , Violência/prevenção & controle , Epidemias/legislação & jurisprudência , Armas de Fogo/legislação & jurisprudência , Humanos , Assistência Perioperatória/tendências , Médicos/tendências , Fatores de Tempo , Violência/legislação & jurisprudência , Violência/tendênciasRESUMO
BACKGROUND: A significant percentage of elderly patients suffer from both polypharmacy and visual impairment. This combination can increase the risk of an adverse event related to medication. This case highlights an unusual, but potentially deadly, medication adverse event. CASE PRESENTATION: A 77-year-old male, visually impaired, ingested a pill desiccant, believing it was the ampicillin/sulbactam tablet he was prescribed for an infected diabetic foot ulcer. He presented to the emergency room with inability to swallow, and imaging revealed the pill desiccant lodged in his upper esophagus. He developed respiratory distress due to aspiration of secretions, necessitating intubation both to protect his airway and for an esophagogastroduodenoscopy (EGD). During EGD the desiccant was pushed into the stomach due to an inability to remove it without causing harm. Patient self-extubated the following day and per family and patient's wishes was not re-intubated. The patient suffered no further complications directly related to the desiccant, but he died several days later from respiratory failure. CONCLUSIONS: This case highlights a concerning medication patient safety issue for visually impaired geriatric patients.
Assuntos
Distúrbios Induzidos Quimicamente , Endoscopia do Sistema Digestório/métodos , Higroscópicos/efeitos adversos , Intubação Intratraqueal/métodos , Insuficiência Respiratória , Transtornos da Visão/complicações , Idoso , Distúrbios Induzidos Quimicamente/diagnóstico , Distúrbios Induzidos Quimicamente/etiologia , Distúrbios Induzidos Quimicamente/fisiopatologia , Distúrbios Induzidos Quimicamente/terapia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Serviços Médicos de Emergência/métodos , Evolução Fatal , Humanos , Masculino , Segurança do Paciente , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapiaAssuntos
Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/tendências , Complicações Pós-Operatórias/induzido quimicamente , Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/tendências , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/prevenção & controleRESUMO
Pancreaticopericardial fistula (PPF) is a rare subset of thoracopancreatic fistulas with few reported cases in the literature. Historically, treatment of PPF has included pancreatic ductal stenting or surgery, or both, but we present a case of PPF that was successfully treated using only pericardial and pancreatic drains.
Assuntos
Drenagem , Fístula Pancreática/terapia , Pseudocisto Pancreático/terapia , Derrame Pericárdico/terapia , Idoso de 80 Anos ou mais , Colangiopancreatografia por Ressonância Magnética , Humanos , Masculino , Fístula Pancreática/diagnóstico , Pseudocisto Pancreático/diagnóstico por imagem , Pancreatite Alcoólica/complicações , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologiaRESUMO
The Veterans Healthcare Administration (VA) has embraced patient safety and quality improvement in the quest to improve care for veterans. The New Mexico VA Health Care System introduced a new morbidity and mortality conference, called the Interdisciplinary Quality Improvement Conference (IQIC), using patient case presentations to focus on underlying systems in the clinical care environment. The revised conference design also effectively teaches the 6 Accreditation Council for Graduate Medical Education (ACGME) core requirements for resident education. A formal process was established for case selection, presentation, systems issue identification, tracking, and follow-up. The IQIC has enabled the identification of more than 20 system issues at the study institution. Outcome data show lasting improvement in system issues that were addressed by this mechanism. The VA IQIC is an effective method to both identify and correct systems issues that affect patient care and is an effective method for teaching residents the 6 ACGME requirements for residency education.
Assuntos
Administração Hospitalar , Melhoria de Qualidade/organização & administração , Comunicação , Comportamento Cooperativo , Educação de Pós-Graduação em Medicina/organização & administração , Humanos , Aprendizagem , New Mexico , Segurança do Paciente , Papel Profissional , Estados Unidos , United States Department of Veterans AffairsRESUMO
This case report describes the rare phenomenon of malignant conversion of benign right ventricular outflow tract ventricular tachycardia into idiopathic ventricular fibrillation 18 years after successful ablation, in the absence of any type of heart disease. We review the current literature looking at predictors for this event, with the conclusion that there are no reliable risk predictors available. Until clear guidelines exist, we suggest patients be informed and monitored for the possibility of "malignant conversion" following ablation for benign idiopathic outflow tract ventricular tachycardia.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Assistência Perioperatória/métodos , Período Perioperatório , Trombose/induzido quimicamente , Anti-Inflamatórios não Esteroides/farmacologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Arritmias Cardíacas/epidemiologia , Humanos , Risco , Taquicardia/induzido quimicamente , Taquicardia/fisiopatologia , Trombose/epidemiologiaRESUMO
OBJECTIVE: To provide an evidence-based focused review of aspirin use in the perioperative period along with an in-depth discussion of the considerations and risks associated with its preoperative withdrawal. BACKGROUND: For patients with established cardiovascular disease, taking aspirin is considered a critical therapy. The cessation of aspirin can cause a platelet rebound phenomenon and prothrombotic state leading to major adverse cardiovascular events. Despite the risks of aspirin withdrawal, which are exacerbated during the perioperative period, standard practice has been to stop aspirin before elective surgery for fear of excessive bleeding. Mounting evidence suggests that this practice should be abandoned. METHODS: We performed a PubMed and Medline literature search using the keywords aspirin, withdrawal, and perioperative. We manually reviewed relevant citations for inclusion. RESULTS/CONCLUSIONS: Clinicians should employ a patient-specific strategy for perioperative aspirin management that weighs the risks of stopping aspirin with those associated with its continuation. Most patients, especially those taking aspirin for secondary cardiovascular prevention, should have their aspirin continued throughout the perioperative period. When aspirin is held preoperatively, the aspirin withdrawal syndrome may significantly increase the risk of a major thromboembolic complication. For many operative procedures, the risk of perioperative bleeding while continuing aspirin is minimal, as compared with the concomitant thromboembolic risks associated with aspirin withdrawal. Those cases where aspirin should be stopped include patients undergoing intracranial, middle ear, posterior eye, intramedullary spine, and possibly transurethral prostatectomy surgery.
Assuntos
Aspirina/uso terapêutico , Hemorragia/etiologia , Assistência Perioperatória , Inibidores da Agregação Plaquetária/uso terapêutico , Aspirina/farmacologia , Plaquetas/efeitos dos fármacos , Procedimentos Cirúrgicos Cardíacos , Doenças Cardiovasculares/prevenção & controle , Humanos , Cirurgia de Mohs , Procedimentos Ortopédicos , Período Perioperatório , Inibidores da Agregação Plaquetária/farmacologia , Trombose/prevenção & controle , Procedimentos Cirúrgicos Urológicos , Procedimentos Cirúrgicos VascularesRESUMO
We report a case of fatal disseminated infection with Cryptococcus gattii in a patient from New Mexico. The patient had no history of recent travel to known C. gattii-endemic areas. Multilocus sequence typing revealed that the isolate belonged to the major molecular type VGIII. Virulence studies in a mouse pulmonary model of infection demonstrated that the strain was less virulent than other C. gattii strains. This represents the first documented case of C. gattii likely acquired in New Mexico.
Assuntos
Criptococose/microbiologia , Cryptococcus gattii/fisiologia , Animais , Autopsia , Encéfalo/microbiologia , Encéfalo/patologia , Criptococose/patologia , Cryptococcus gattii/classificação , Cryptococcus gattii/genética , Cryptococcus gattii/patogenicidade , Evolução Fatal , Genótipo , Humanos , Pulmão/microbiologia , Pulmão/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , New Mexico , Filogenia , VirulênciaRESUMO
OBJECTIVE: To review the ages of patients with recurrent herpes simplex virus type 2 (HSV-2) meningitis. DESIGN: Case report and literature review back to 1970. SETTING: Referral Veterans Affairs hospital. RESULTS: Our patient developed his first episode of recurrent HSV-2 meningitis at 78 years of age, 57 years after his only episode of genital herpes simplex infection. Of 223 patients in the literature with recurrent HSV-2 meningitis, 5% occurred in patients older than 60 years and 19% in patients older than 50 years. CONCLUSIONS: Although recurrent meningitis due to HSV is primarily seen in young, sexually active adults, a surprising number of episodes of HSV meningitis can develop in older age. Meningitis due to HSV-2 should be in the differential diagnosis of aseptic meningitis in older patients.
Assuntos
Herpes Simples/etiologia , Herpesvirus Humano 2/patogenicidade , Meningite/etiologia , Adulto , Fatores Etários , Idoso , Feminino , Herpes Simples/complicações , Humanos , Masculino , Meningite/complicações , Meningite/virologia , PubMed/estatística & dados numéricos , Recidiva , Fatores SexuaisAssuntos
Articulação do Tornozelo/microbiologia , Artropatias/microbiologia , Osteomielite/diagnóstico , Infecções Estafilocócicas/diagnóstico , Tuberculose Osteoarticular/diagnóstico , Diagnóstico Diferencial , Feminino , Infecções por HIV/diagnóstico , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Fatores de TempoRESUMO
BACKGROUND: To review the presentation of Bacteroides fragilis (B fragilis) spondylodiscitis. METHODS: Two investigators independently searched the published English, Spanish and French languages literature through September 2005 using MEDLINE (1966-2005). We included all reported cases of vertebral osteomyelitis or spondylodiscitis caused by B fragilis, not related to sacral decubitus ulcers, in adults (age 16 yr and above). A third author independently reviewed all articles and extracted data for accuracy. The final pool of eligible publications included 11 articles, publication dates ranging from 1978 to 2005. Eight were written in English, two in Spanish, and one in French. RESULTS: The age of the patients in this series ranged from 17 to 74 years, with a mean age of 55 years. Male to female ratio was 6:1. Lumbar involvement was reported in nine cases, thoracic involvement in two patients and sacral involvement in one patient. B fragilis was recovered by blood culture in four patients and by tissue culture in eight patients. Metronidazole was the most common antibiotic used for treatment (eight patients), either as monotherapy or in combination with other antibiotics. CONCLUSIONS: B fragilis is a rare causative agent of spondylodiscitis, but it should be considered in patients with spondylodiscitis who have contiguous intraabdominal or pelvic infections or who had recent gastrointestinal procedures that may have led to B fragilis bacteremia.