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At least 1,603 records · Page 89Linked to original sources
PubMed2001

A common-source water-borne outbreak of multidrug-resistant typhoid fever in a rural Thai community.

We report an epidemiological investigation of an explosive water-borne outbreak caused by multidrug-resistant (MDR) Salmonella Typhi in a non-endemic community with otherwise good sanitation. Between 31 October and 11 November 1999, 11 cases of typhoid fever occurred in Poppra District, Tak Province. Four cases were children < or = 14 years of age and the remaining 7 were adults 15-24 years old. Hemoculture was performed in 10 of the 11 cases, of whom 5 (50.0%) were positive for Salmonella Typhi. All the isolates were of Vi phage type E14 which was resistant to chloramphenicol, ampicillin, co-trimoxazole, tetracycline, and streptomycin but sensitive to kanamycin, ofloxacin, ciprofloxacin, and cefotaxime. One confirmed case developed intestinal perforation leading to death. A case-control study revealed a significant association between disease and drinking unboiled spring water. The implication of spring water was supported by the presence of faecal contamination in the spring water source. Rapid identification of the possible transmission source and prompt implementation of control measures curtailed the spread of this outbreak.

Adolescent↗
PubMed2001

Osteosarcoma of the bladder--a case report.

A 25-year old man with hematuria had a polypoid tumor of the urinary bladder which was diagnosed as transitional cell carcinoma (TCC) on transurethral resection with partial cystectomy. One year following post-operative radiotherapy, he had to undergo surgery for intestinal perforation. On laparotomy the recurrent tumor had involved pelvic organs and sigmoid colon. It now showed predominantly osteogenic sarcoma on histopathologic examination. The case is reported in view of rarity of primary osteogenic sarcoma in the urinary bladder.

Adult↗
PubMed2002

[Pneumatosis cystoides intestinalis in emergencies: clinical management and treatment. 2 case reports].

Pneumatosis Cystoides Intestinalis gives many diagnostic and therapeutic troubles especially when it occurs in patient admitted in an emergency setting. The Authors report two cases of PCI related to patients admitted into the Emergency Department (DEA II) with diagnosis of intestinal perforation, mode according to the radiological findings of free subfrenic air, but not confirmed at physical examination. The Authors discuss the role that imaging and physical examination play in evaluating this kind of patients, considering the etiopathogenetic hypothesis about this rare disorder.

Aged↗
PubMedDate not supplied

Retrospective analysis of typhoid fever in a tropical tertiary health facility.

A retrospective analysis of cases diagnosed as typhoid fever over a ten-year period at the University College Hospital, Ibadan, Nigeria was carried out to assess the presentation pattern, laboratory investigation, mortality and mode of therapy. Incidence was of typhoid fever was highest in the dry months of the year. The mean age of survivors and the dead are 25.7 and 21.9 years respectively. Most of the patients presented with fever, abdominal pains and other gastrointestinal symptoms such as vomiting, constipation and diarrhoea. There was no specific temperature pattern but pulse rate > or = 120/minute was significantly associated with mortality. The commonest complication was intestinal perforation followed by haemorrhage with septic shock playing a prominent role in mortality. Mortality rate of 22.2% was recorded which is not significantly different from the 24% recorded at the same centre over three decades ago and most of them died within nine days of admission with 50% dying within 3 days. Most patients were scantily investigated with poor yield on blood, stool and urine cultures. Widal's test was not a favoured investigation and was not helpful in diagnosis. Chloramphenicol was the drug of choice as monotherapy, while metronidazole and gentamicin were used in cases of gut perforation. It is concluded that typhoid fever is still a major health concern in the tropics and efforts need to be geared up to combat this preventable scourge by improvement in basic necessities of life such as potable water, hygienic food in addition to health education.

Adult↗
PubMedDate not supplied

[HUMAN BALANTYDIASIS IN HUARAZ: REPORT OF FIVE CASES]

In order to know the clinical behavior of Human Balantidiasis, five symptomatic cases are reported (three from hospital and two from private practice), observed from December 1993 to December 1996 in the city of Huaraz (3,100 Mt above sea level). All patients were from Ancash, being their mean age 57,2 years old (3-85); 4/5 were male, and 3/5 were farmers. They bred pigs, lived in a rural environment and had no access to drinking water nor to sewage at home. The mean length of this disease was 22,8 days (10-60). Clinical symptoms were dysenteric diarrhea and abdominal pain accompanied by fever, pallor, asthenia, weight loss and dehydration. All five cases presented the parasite in the feces: one as a cyst, two as trophozolte, and the other two, both shapes. Two patients suffered serious complications: The first one had intestinal perforation, peritonitis and died, and the other one presented bronchopneumonia, low digestive hemorrhage and sepsis. Treatment included tetracycline, metronidazole and large spectrum antibiotic, if required. When we observe a patient with hemorrhagic or chronic severe diarrhea in Huaraz, who comes from the rural area and is a breeder of pigs, we must consider a diagnosis based on Human Balantidiasis.

Journal Article↗
PubMed2002

[Therapeutic strategy in acute necrotizing pancreatitis].

We describe our therapeutic principles in connection with the treatment of 43 patients (30 male and 13 female) with acute necrotizing pancreatitis. The etiology of the disease was alcohol in 72.1%, gallstones in 23.3%, trauma, hyperlipidemia, ERCP and unknown in 4.7%. In all patients, the necrosis was proved by CT and histological examination. The patients were treated in intensive care unit. It involved prophylactic antibiotics (Imipenem) and early nasojejunal feeding. In each case, we endeavoured to delay surgery, which was a wide necrosectomy extending to the retroperitoneum. In 13 patients (30.2%) CT-guided percutaneous drainage was performed because of extensive peripancreatic fluid. Ten such patients were operated on at a later time. In 81.4% (35 patients) an average of 1.8 operations were performed. The first indications were acute abdomen, septic necrosis and multi-organ failure (MOF) unreactive to conservative therapy. Five patients (11.6%) were cured with conservative treatment and 3 patients (7%) were cured by treatment which included percutaneous drainage. Twenty-seven reoperations were performed in 12 patients because of sepsis, suspected peritonitis, abscess, bleeding and gastro-intestinal perforation. The average hospital stay was 44.5 days (3-120 days) long, and mortality was 16.2%. In our opinion in addition to intensive therapy, prophylactic antibiotics, early nasojejunal feeding and late, delayed surgery are important in the treatment of acute necrotizing pancreatitis. Percutaneous peripancreatic drainage is a useful way to delay operation. These therapeutic possibilities improve the survival rate of patients with pancreatic necrosis.

Adult↗
PubMed2002

[Echography performed by surgeons in the management of patients with trauma].

BACKGROUND: Ultrasonography is useful in trauma patients to detect pleural effusions or peritoneal fluid. AIM: To assess the value of ultrasonography performed by surgeons in the assessment of trauma patients. MATERIAL AND METHODS: A retrospective review of ultrasonography reports and clinical history of 284 trauma patients. RESULTS: One hundred fifty six patients had blunt trauma and 128 had penetrating trauma. Ultrasonography detected peritoneal fluid in 20%, pericardial effusion in 1% and pleural effusion in 1%. Eight percent had visceral damage or hematomas, without peritoneal fluid. None of the patients with a normal ultrasonography required surgery for hemoperitoneum; however, four patients had intestinal perforations and required surgery. CONCLUSIONS: Ultrasonography had a 100% sensitivity and specificity for the detection of clinically significant hemoperitoneum. Emergency ultrasonography performed by surgeons is useful and accurate.

Adult↗
PubMed2003

Laparoscopic evaluation in incarcerated groin hernia following spontaneous reduction.

The authors report their initial experience of diagnostic laparoscopy in a baby presenting with small bowel obstruction secondary to strangulated groin hernia. Laparoscopy was accomplished through ipsilateral hernia sac to determine the viability of the incarcerated bowel segment under general anesthesia, following spontaneous reduction under general anesthesia. Diagnostic laparoscopy showed edematous intestinal segments but no sign of necrotic bowel or indirect findings of intestinal perforation. Diagnostic laparotomies may be useful in selected cases preventing an unnecessary laparotomies.

Diagnosis, Differential↗
PubMedDate not supplied

Clinical trial of sulbactam/ampicillin in the treatment of typhoid fever, and in-vitro sensitivity of isolates to sulbactam/ampicillin and chloramphenicol.

A trial of Sulbactam/Ampicillin in treatment of typhoid fever was carried out while in-vitro sensitivity of the drug was compared with chloramphenicol. Sulbactam/Ampicillin was found to be effective in 11 out of 12 patients who received the drug. The 1 patient who failed to respond had intestinal perforation with peritonitis. No side effects were encountered. The in-vitro study showed that 91.7% of the isolates were sensitive to sulbactam/ampicillin compared to 75% sensitivity to chloramphenicol. The difference was however not statistically significant (P < 0.05). It is concluded that sulbactam/ampicillin is effective and safe in the treatment of typhoid infection.

Adolescent↗