RESUMEN
INTRODUCTION: Lemierre's syndrome is defined as an oropharyngeal infection due to Fusobacterium necrophorum, associated with septic thrombophlebitis of the internal jugular vein. The uncommon pelvic variant of the syndrome is a rare condition, poorly described in literature. CASE REPORT: We report a case of gynecological Lemierre's syndrome in a 19-year-old woman after a first sexual intercourse, who presented acute respiratory failure, left internal iliac vein thrombosis with pulmonary embolism, in the setting of salpingitis and F. necrophorum bacteriemia. CONCLUSION: Gynecological Lemierre's syndrome is a rare and unrecognized condition, which could be lethal. Early recognition of the disorder enables initiation of appropriate antibiotic therapy for 4 to 6 weeks, and discussion of anticoagulant therapy which indications are not yet well defined.
Asunto(s)
Infecciones por Fusobacterium/diagnóstico , Síndrome de Lemierre/diagnóstico , Infecciones del Sistema Genital/diagnóstico , Antibacterianos/uso terapéutico , Femenino , Infecciones por Fusobacterium/tratamiento farmacológico , Infecciones por Fusobacterium/microbiología , Fusobacterium necrophorum/aislamiento & purificación , Humanos , Vena Ilíaca/microbiología , Vena Ilíaca/patología , Síndrome de Lemierre/tratamiento farmacológico , Síndrome de Lemierre/microbiología , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/microbiología , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/tratamiento farmacológico , Síndrome de Dificultad Respiratoria/microbiología , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/microbiología , Tromboflebitis/diagnóstico , Tromboflebitis/tratamiento farmacológico , Tromboflebitis/microbiología , Adulto JovenAsunto(s)
Vena Ilíaca/microbiología , Venas Renales/microbiología , Sepsis/microbiología , Espondilitis/microbiología , Infecciones Estafilocócicas/complicaciones , Venas Cavas/microbiología , Trombosis de la Vena/microbiología , Femenino , Humanos , Laminectomía , Vértebras Lumbares/microbiología , Vértebras Lumbares/cirugía , Persona de Mediana Edad , Sepsis/etiología , Espondilitis/complicaciones , Espondilitis/cirugía , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus , Resultado del Tratamiento , Trombosis de la Vena/etiologíaRESUMEN
The authors report the case of a patient who developed a thrombosis of the right iliac vein involving also the inferior vena cava (IVC), in association with Candida sepsis. Despite adequate and prolonged antimycotic treatment, the patient recovered from the fungal sepsis only following the surgical removal of the infected thrombus.
Asunto(s)
Candidiasis/diagnóstico , Vena Ilíaca/microbiología , Sepsis/microbiología , Venas Cavas/microbiología , Trombosis de la Vena/microbiología , Candida albicans/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Trombosis de la Vena/cirugíaAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Absceso/complicaciones , Edema/etiología , Fiebre/etiología , Infecciones por Bacterias Grampositivas/diagnóstico , Lactococcus lactis/aislamiento & purificación , Tromboflebitis/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Vena Ilíaca/microbiología , Conducto Inguinal , Lactococcus lactis/patogenicidad , Masculino , Tromboflebitis/complicaciones , Tromboflebitis/microbiologíaRESUMEN
BACKGROUND: Arterial or venous homografts are frequently implanted for vascular reconstruction in orthotopic liver transplantation (OLT). When fresh vascular homografts (VH) from the same donor were not available, VH from another donor preserved at 4 degrees C in Terasaki (Ter) solution (modified lymphocyte culture medium) were used. METHODS: The clinical results after implantation of Ter-stored VH versus fresh VH in the revascularization of pediatric OLT were studied retrospectively. Short- and long-term follow-up of vascular patency was carried out by doppler ultrasonography in each case. A histological and bacteriological study of nonimplanted VH stored at 4 degrees C in saline (Sal), Ter and University of Wisconsin (UW) solutions for various time periods (days 0-28) was also undertaken. RESULTS: Between 1989 and 1996, 21 iliac arteries and 21 iliac veins preserved in Ter solution (mean preservation time: 8 days; range 1-26) and 100 fresh VH (68 arteries and 32 veins) (preservation time: 8 hr, range 4-21) were used in pediatric OLT. Thrombosis rates were 0 of 21 for stored arteries vs. 7 of 68 (10%) for fresh arteries (NS) and 3 of 21 (14%) for stored veins vs. 3 of 32 (9%) for fresh veins (NS). Actuarial graft survival rates were similar in both groups. Histological analysis of stored, nonimplanted VH invariably showed endothelial destruction within 24-48 hr after procurement. The bacteriological study showed contamination rates of 14 of 25 (56%) for Sal-stored VH, 5 of 25 (20%) for UW, and 1 of 19 (5%) for Ter (Sal vs. UW and Sal vs. Ter: P<0.01; UW vs. Ter: NS). CONCLUSIONS: Ter-preserved cadaveric VH could be safely used in OLT despite early destruction of endothelium.
Asunto(s)
Criopreservación , Arteria Ilíaca/trasplante , Vena Ilíaca/trasplante , Trasplante de Hígado , Hígado/cirugía , Adenosina , Adolescente , Alopurinol , Bacterias/aislamiento & purificación , Niño , Preescolar , Endotelio Vascular/patología , Glutatión , Humanos , Arteria Ilíaca/microbiología , Arteria Ilíaca/patología , Arteria Ilíaca/fisiopatología , Vena Ilíaca/microbiología , Vena Ilíaca/patología , Vena Ilíaca/fisiopatología , Lactante , Insulina , Soluciones Isotónicas , Soluciones Preservantes de Órganos , Complicaciones Posoperatorias , Rafinosa , Estudios Retrospectivos , Trombosis/etiología , Donantes de Tejidos , Grado de Desobstrucción VascularRESUMEN
Two children are presented in whom thrombosis of the inferior vena cava developed in association with an acute staphylococcal osteomyelitis. One case involved the left femur and the other the left ileum. Both children had diffuse bilateral staphylococcal pneumonia from presumed septic embolization. There were close similarities between their illness and management, except that the child who survived underwent a caval thrombectomy in the acute phase of her illness. It is hypothesized that the thrombectomy played an important role in her recovery.
Asunto(s)
Osteomielitis/microbiología , Infecciones Estafilocócicas , Trombectomía , Trombosis/microbiología , Vena Cava Inferior/microbiología , Enfermedad Aguda , Bacteriemia/cirugía , Preescolar , Embolia/microbiología , Resultado Fatal , Femenino , Vena Femoral/microbiología , Vena Femoral/patología , Fémur/microbiología , Humanos , Íleon/microbiología , Vena Ilíaca/microbiología , Vena Ilíaca/patología , Osteomielitis/cirugía , Neumonía Estafilocócica/etiología , Trombosis/cirugía , Vena Cava Inferior/patologíaRESUMEN
AIMS: To attempt to detect Chlamydia pneumoniae DNA in atheromatous vascular tissue. METHODS: A modification of an existing polymerase chain reaction (PCR) assay and immunofluorescence staining with a monoclonal antibody directed against C pneumoniae were used to detect C pneumoniae. Specimens from 32 patients undergoing abdominal aortic aneurysm repair were examined. Vascular tissue, ostensibly normal, from six liver transplant donors was also examined for comparison. Altogether, 43 vessels from these 38 subjects (age range 36-85 years) were examined. RESULTS: C pneumoniae was detected in 11 (44%) of 25 aortas, five (55%) of nine iliac arteries, two (40%) of five femoral arteries, and one of two iliac veins. Immunofluorescence staining supported positive PCR results in three of 12 cases in which it was used. Overall, C pneumoniae was detected in the arteries of 14 (44%) of the patients undergoing vascular surgery and three (50%) of the donors. CONCLUSIONS: This study is the first in the UK in which C pneumoniae organisms have been found in atherosclerotic vessels and the tendency for the organisms to be present most often in such vessels exhibiting chronic inflammatory changes suggests that a search for them in various forms of arteritis may also be rewarding.