ObjectiveTo summarize the clinical characteristics and treatment of acute cellulitis of shank after total knee arthroplasty.
MethodsWe retrospectively analyzed the clinical data of five patients with delayed acute cellulitis of shank after total knee arthroplasty treated in our hospital between January 2008 and January 2013. The clinical characteristics, treatment and prognosis of the disease were then summarized and analyzed.
ResultsThe delayed acute cellulitis of shank after total knee arthroplasty was mainly caused by tinea pedis, which resulted in skin damage and bacteria diffusion. The main clinical manifestations were pain and swelling around the knee joint and shank. The laboratory test found the increasing of C-reactive protein, erythrocyte sedimentation rate, white blood cell and neutrophils. Two cases were caused by hemolytic streptococcus according to blood culture. All patients were discharged after treatment without periprosthetic infection.
ConclusionAccording to the typical clinical manifestations and laboratory test, the diagnosis of delayed acute cellulitis of shank is not difficult. Timely and comprehensive treatment should be emphasized to seek and eradicate the primary lesions, such as tinea pedis, subcutaneous ulcer and carbuncle.
To investigate the method of using vacuum seal ing drainage (VSD) technique to repair the wound of the injured in Wenchuan earthquake and its therapeutic effect. Methods From May 12, 2008 to June 12, 2008, 52 injured persons (83 wounds) were treated, including 27 males and 25 females aged 11-83 years old (average 42 years old). There were 22 cases of crush injury, 9 cases of contusion and laceration injury, 17 cases of compression injury receiving incision decompression of fascia compartment and 4 cases of open amputation. And 37 wounds were on the leg, 13 woundson the thigh, 17 wounds on the forearm, 11 wounds on the upper arm and 5 wounds on the trunk. The wound ranged from3 cm × 2 cm to 30 cm × 15 cm, and the time from injury to undergoing VSD treatment was 12 hours-18 days. After complete debridement, the wound was covered by VSD dressing, and antibiotics were given according to the result of drug sensitive test. When wound infection was under control and granulation tissues grew well, the method of either direct suture or skin grafting or flap transposition was used to repair the wounds. Results In 21 cases (40.4%), wound secretion smear was positive, and multiple species of bacteria were detected, such as staphylococcus aureus, escherichia col i, proteus and klebsiella pneumoniae. After initial operation, 7 injured persons were transferred to the hospital outside of Sichuan province for further treatment. VSD treatment was performed on 33 cases (45 wounds) once, 6 cases (10 wounds) twice, 2 cases (3 wounds) three times and 1 case (1 wound) four times, resulting in the control of wound infection and the growth of granulation tissue. Then the wounds were repaired by either direct suture or skin grafting or flap transposition. Three cases (4 wounds) underwent VSD treatment ten times, leading to the control of infection and the stabil ity of condition. Conclusion VSD treatment can cover the wound promptly, el iminate contamination, prevent secondary infection and benefit late-stage wound repair. During the process of treatment, no medical necessity for frequent change of dressing can rel ieve the pain suffered by the injured and decrease theworkload of medical stuff, thus facil itating the rescue work.
Objective To investigate the clinical characteristics of acute myocardial infarction ( AMI) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods Clinical data of 16 elderly patients with AECOPD and AMI from may 2007 to December 2009 were reviewed. Meanwhile, 128 elderly AECOPD patients without AMI were analyzed as control. Results Neither the AMI group nor the control group had typical precordial pain, conscious disturbance, andhypotension. Compared with the control group, the main symptoms of the AMI group were worsening of chest tightness and dyspnea( 16 /16 vs. 4/128, P lt;0. 01) ,most of which accompanying fever( 11/16 vs. 6/128, P lt;0. 05) and anorexia ( 10/16 vs. 23 /128, P lt; 0. 05) . The incidence of patches-like shadow on chest X-rayincreased ( 16 /16 vs. 62/128, P lt;0. 05) , PaO2 ( mm Hg) decreased ( 43. 72 ±3. 64 vs. 82. 26 ±11. 41, P lt;0. 001) , the red blood cell count ( ×1012 /L) increased ( 6. 43 ±0. 42 vs. 4. 11 ±1. 24, P lt; 0. 05) , the concentration of total cholesterol ( mmol /L) increased ( 6. 51 ±0. 84 vs. 3. 93 ±1. 14, P lt; 0. 05) , the needfor invasive mechanical ventilation increased ( 13/16 vs. 11 /128, P lt; 0. 05) , the days in hospital were prolonged ( 35 ±13 vs. 11 ±3, P lt; 0. 01) , the cost ( 1000 RMB) increased( 32 ±11 vs. 7. 6 ±2. 8, P lt;0. 01) , and the mortality also increased ( 2/16 vs. 3 /128, P lt;0. 01) . Conclusion AMI should be alerted in the case of sudden exacerbation of chest tightness and dyspnea in elderly patients with AECOPD.
ObjectiveTo explore the diagnosis and treatment of severe adenovirus pneumonia patients with severe acute respiratory distress syndrome (ARDS) in a short time and reduce the complications after rehabilitation. MethodsThe clinical data, laboratory results, treatment process and imaging outcomes of three severe community-acquired adenovirus pneumonia patients with normal immune function were analyzed. ResultsAll the three patients developed ARDS in a very short time. In the early stage, alveolar lavage fluid obtained by fiberoptic bronchoscopy was taken for macrogenomic second-generation sequencing (mNGS), adenovirus was detected and antiviral drugs were immediately used. The first two patients received cidofovir antiviral therapy and the third patient received ribavirin antiviral therapy. All three patients received very high respiratory support, of which the first two received extracorporeal membrane oxygenation treatment. The lungs of all three patients recovered well after treatment. ConclusionsThe diagnosis and treatment of severe adenovirus pneumonia is still based on individualized symptomatic support, immune regulation and treatment of complications. mNGS can help diagnose and direct treatment of adenovirus pneumonia as early as possible, which is beneficial to reduce complications and improve survival rate.
Objective To review the association between chlamydia pneumoniae (CP) infection and cerebral infarction. Methods We electronically searched MEDLINE, BIOSIS, VIP database, and China Full Text Journal Database from Jan. 1990 through Dec. 2007 to identify case-control studies about the association of CP and cerebral infarction. The quality of the included studies was assessed and the RevMan 4.2 software was used for meta-analyses. Results A total of 22 studies were included. The results of meta-analyses showed: ① When the microimmunofluorescence (MIF) method was used to examine CP antibody in serum, the positive rate of the cerebral infarction group was higher than that of the control group when the positive infection was defined by IgA≥1?16 [n=8, OR=2.18, 95%CI (1.49 to 3.49), Plt;0.0001]; but when positive infection was defined by IgA≥1?32 (n=3), IgG≥1?32 (n=6), or IgG≥1?64 (n=5), there were no significant differences in the positive rate between the two groups [OR (95%CI) were 1.47 (0.97 to 2.24), 1.24 (0.82 to 1.86), and 1.23 (0.98 to 1.55), respectively]; ② When the ELISA method was used to examine CP-IgG antibody in serum, the positive rate of the cerebral infarction group was higher than that of the controlled group [n=8, OR=2.40, 95%CI (1.42 to 4.06), P=0.000 2]. ③ The acute and chronic CP infections were associated with the incidence of cerebral infarction [n=4, OR=7.22, 95%CI (2.68 to 19.49); n=4, OR=4.30, 95%CI (3.40 to 7.40)]. Conclusion ① The association between CP infection and cerebral infarction is determined by the positive criterion. IgA antibody is more sensitive than the IgG antibody. When the positive infection is determined by IgA≥1?16, CP infection is associated with cerebral infarction. ② The results of ELISA for examining CP-IgG support the association between CP infection and cerebral infarction. ③ Both acute and chronic CP infections are associated with cerebral infarction, but these associations needed to be proven by more scientific studies.
ObjectiveTo investigate the correlation between infection and capsular contracture by observing the effect of infection on the formation of the surrounding capsule after breast implants.
MethodsThree healthy adult female Diannan small-ear pigs underwent augmentation mammaplasty using miniature implants, which were randomly divided into group A (12 nipples), group B (10 nipples), and group C (12 nipples). Staphylococcus epidermidis (SE ATCC12228 and SE RP62A, 1.2×105 CFU/mL) was inoculated into the periprosthetics of groups B and C, and sterile PBS in group A before breast implants. Then the silica gel prosthesis was put, total 34 implants in 3 groups. After 13 weeks, the capsule was harvested to measure the capsular tension and weight. HE staining was used to observe the structure characteristics of the capsule and to measure the capsule thickness, Van-Gieson (VG) staining to observe the capsule collagen characteristics, and α-smooth muscle actin (α-SMA) immunocytochemistry staining to observe myofibroblasts in capsule.
ResultsPrimary healing of incision was obtained, and 3 small-ear pigs showed stable life indication. The complete fibrous capsule was observed after 13 weeks in 3 groups. Capsule tension showed no significant difference among 3 groups (P>0.05). Capsule weight was significantly greater in group C than in groups A and B (P<0.05). HE staining showed that capsule structure of the 3 groups was similar with obvious dense layer and loose layer, and the capsule thickness was also significantly greater in group C than in groups A and B (P<0.05), but no significant difference was found between groups A and B (P>0.05). VG staining showed that collagenous fiber in the capsule were more compact in group C than in groups A and B. The α-SMA immunocytochemistry staining indicated the myofibroblasts in capsule were the most in group C.
ConclusionInfection after breast implants has obvious impacts on the formation of the capsule, and there was a causal link between infection and capsular contracture.
Objective To study the diagnostic procedures and management of aortic stent graft infection. Methods Clinical data of 4 patients with aortic stent graft infection from 1998 to 2008 were analyzed retrospectively. Results Primary disease was thoracic endovascular aortic repair in 2 cases and endovascular aneurysm repair in another 2 cases. Constitutional symptoms and abscess information on imaging studies were presented in all patients. Salmonella choleraesuis was revealed in 2 cases. Surgical debridement, drainage and systematic antimicrobial therapies were given to 2 patients. The remaining 2 patients were managed with antimicrobial therapy only. During follow-up, there was no recurrence of infection. Conclusions Infection of aortic stent graft infection is a rare but potentially devastating complication. Radiologic studies can serve as important adjuncts in the diagnosis of endovascular graft infections. Several treatment options are available, some cases may be managed with conservative treatment.
ObjectiveTo explore the infection condition of Acinetobacter baumannii at the Neurosurgery Intensive Care Unit (NICU), and analyze the possible risk factors.
MethodsWe retrospectively analyzed the clinical data of Acinetobacter baumannii infection patients with craniocerebral injury treated at the NICU between January 2011 and June 2013. We collected such information as infection patients' population distribution, infection site, invasive operations and patients' nurse-in-charge level and so on, and analyzed the possible risk factors for the infection.
ResultsThirty-one patients were infected with Acinetobacter baumannii, and they were mainly distributed between 60 and 80 years old. The main infection site was lower respiratory tract, followed in order by urinary tract, gastrointestinal tract, skin and soft tissue. The risk factors might be related to age, invasive operation, nurse working ability, etc.
ConclusionThe patients at the NICU are vulnerable to infection of Acinetobacter baumannii. Reducing invasive diagnosis and nursing procedures, providing optimal care, and carrying out specialized nurse standardization training may be the important means to effectively reduce the infection.
The prevention and control of hospital infection should be precise. Otherwise, a lot of medical resources will be wasted. To achieve accuracy, prevention and control should be considered from the microbial level to enhance its scientific nature. It is specifically reflected in the need of having knowledge of microorganisms, understanding the pathogens of infection and their transmission routes, therefore to carry out prevention and control work contrapuntally. Specific measures include infection surveillance at the microbial level, establishing the idea and habits of infection diagnosis from the microbial level, being familiar with microbial perspective to identify infection risks and vulnerabilities, implementing evidence-based prevention and control measures for different pathogens, encouraging researches on infection control and management at the microbial level, and developing precise prevention and control regulations, standards, or guidelines for specific pathogens.
The limitation of resource of blood and risk of transfusion-transmitted infections contribute to development and generalization of restrictive transfusion strategy. However, advanced evidences of clinical trials indicated a restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. It is time to optimize patient blood management but not free-transfusion and increase of risk of patients. The duration of red-cell storage was not associated with significant differences in the mortality and morbidity of patients. Three new pathogen-reduction technologies and pharmaceutical intervenes may provide safe of transfusion and improvement of outcomes.
