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At least 163 records · Page 9Linked to original sources

Bacterial urinary tract infections in diabetes.

Bacterial UTIs are a common problem in patients with diabetes mellitus. Bacteriuria is more common in diabetic women than in non-diabetics owing to a combination of host and local risk factors. Upper tract disease is also more common in this group. Diabetics are at higher risk for intrarenal abscess, with a spectrum of disease ranging from acute focal bacterial pyelonephritis to renal corticomedullary abscess to the renal carbuncle. A number of uncommon complicated UTIs, such as emphysematous pyelonephritis and emphysematous pyelitis, occur more frequently in diabetics. Because of the frequency and severity of UTI in diabetics, prompt diagnosis and early therapy is warranted.

Abscess↗

[The role of ultrasonic scanning in optimizing the therapy of gestational pyelonephritis].

Urinary tracts were examined by ultrasonic scanning (US) of the kidneys in 130 patients with gestational pyelonephritis. The scanning provided a rapid diagnosis of parenchymal and paranephric fat lesions, of urinary tract occlusion, location of concrements, congenital and acquired renal defects, abscesses, carbuncles. The follow-up US controls the inflammation, permitting differential treatment under reduced exposure to x-rays and radionuclides.

Combined Modality Therapy↗

[Clinical effectiveness of pefloxacin (abaktal)in the treatment of inflammatory diseases of the kidneys, urinary tracts and genital organs].

Pefloxacin (Abaktal) was used in treatment of 83 patients: 14 patients with acute pyelonephritis, 5 patients with carbuncle of the kidney, 17 patients with postoperative acute pyelonephritis, 3 patients with urosepsis, 7 patients with acute prostatitis, 18 patients with chronic pyelonephritis in the phase of active inflammation, 9 patients with exacerbation of chronic prostatitis, 3 patients with acute cystitis, 2 patients with acute urethritis and 5 patients with epididymo-orchitis. Two dosage forms of pefloxacin were used i.e. tablets of 400 mg and ampoules of 5 ml containing 400 mg of the active substance. The treatment course amounted to 7-14 days. In the patients with inflammatory infectious diseases of the lower urinary tracts (cystitis and urethritis) the treatment course amounted up to 5 days. The results of the treatment with the ampoule solutions were good and satisfactory. With the use of the tablets the results were unsatisfactory in 3 patients (8.1 per cent). Satisfactory bacteriological efficacy of the treatment was stated in 89.5 per cent of the cases. The adverse reactions such as nausea, vomiting, diarrhea and skin eruption were recorded in 5 patients (6 per cent).

Bacterial Infections↗

[Ways to improve ambulatory care for patients with surgical infection].

A deep analysis of purulent surgical diseases and purulent complications in 5,780 out-patients was conducted by means of a specially worked out punch card. Four groups were identified posttraumatic purulent complications--accidental wounds, abscesses, phlegmons, panaris, regional lymphadenitis, osteomyelitis, etc.--3,274 (56.6%); purulent diseases--furuncle, carbuncle, suppurating atheroma, hidradenitis, etc.--2,208 (38.2%); postoperative purulent complications--155 (2.7%), and postinjection purulent complications--143 (2.5%). The prevailing therapeutic measures were surgery and antiseptic agents used during treatment (for irrigation and dressings) of the wounds; the efficacy of these agents was of great significance. The effect of three antiseptics was studied: nitrofurazone 1:5000, dimexid, and electrochemically activated water with pH-2.4. The two first antiseptics were applied both in the first and second phases of inflammation, activated water with pH 2.4 was used only in the first phase, and activated water with pH 11.3 was used in wound dressing in the second stage of healing. The average duration of temporary incapacity was 19.7 +/- 3.2 days in 2,661 patients treated with 1:5000 nitroturazone, 16.2 +/- 2.2 days in 2,700 patients treated with dimexid, and 10.3 +/- 1.4 days in 419 patients treated with activated water. Depending on the methods of wound treatment, the economical losses per patient were 1,380, 982, and 624 roubles, respectively.

Adult↗

Linear bacterial dissection.

An unusual case of an erythematous indurated arcuate plaque with a curvilinear appearance was noted after a patient manipulated an ingrown beard hair. During removal of a biopsy specimen, a purulent discharge was expressed that had evidently dissected through the dermis forming this interesting shape. This may be similar to a recently reported entity described by Shelley and Shelley as linear bacterial dissection. Culture of the discharge grew Staphylococcus aureus and Klebsiella pneumoniae. Complete resolution occurred after drainage and antibiotic therapy. Cellulitis and erysipelas typically do not show central clearing or form arcuate plaques. Aside from lymphangitis, thrombophlebitis, and sinus tracts of carbuncles, dermal infectious processes rarely present as linear or arcuate plaques. The differential diagnosis and a review of the literature are presented.

Adult↗

[Complications of a paranephric novocaine block for renal colic].

Under observation were 12 patients, in whom following paranephral novocain blockade subcapsular and paranephral hematomas, purulent paranephritis, abscesses and carbuncles of the kidneys developed. All patients were subjected to surgery. In such cases to eliminate renal colic it would be more safe to perform other kinds of theapeutic procedures (the injection of spasmolytic, the blockade after M. Ju. Lorin-Epshtein method, etc) which are not at all inferior in their effect to paranephral novocain blockade.

Adult↗

[The surgical treatment of suppurative destructive forms of acute pyelonephritis in pregnant women].

The paper presents the results of surgical treatment of pyodestructive pyelonephritis diagnosed in 111 puerperae and gravidae. Suppurative nephritis, carbuncle and abscess of the kidney ran as unilateral (94 patients, 84.7%) or bilateral (16 patients, 14.4%) process. The diagnosis of pyodestructive pyelonephritis of the solitary kidney was made in 1 gravida. The outcomes of pyodestructive pyelonephritis in puerperae and gravidae depend primarily on individual approach to therapy. Different operative interventions warranted a complete response in 97.3% of the gravidae. 96 of 108 gravidae operated on the kidneys delivered viable neonates. Early operative interventions in many cases preserved the kidney and prevented septic complications. Pyodestructive changes restricted to 1-2 segments of the kidney were effectively treated by nephrostomy. Bilateral pyodestructive pyelonephritis should be managed step-by-step starting at the side of the most evident symptoms. Two-stage bilateral lumbotomy with nephrostomy in combination with antibacterial therapy and plasmapheresis eliminated septic complications thus allowing normal development of the fetus. Nephrectomy is the best treatment in advanced pyodestructive lesion with severe life-threatening septic intoxication.

Acute Disease↗

Cellulitis after hip surgery: long-term follow-up of seven cases.

Cellulitis of the buttock after hip surgery is rarely reported, but raises concern about possible infection of the implant. In view of this we have investigated the frequency of previous hip surgery in patients with cellulitis of the hip and/or buttock and assessed for any predisposing factors. A review was made of the case notes of all patients admitted to our department with infectious cellulitis of the hip and/or buttock between 1981 and 1995. Seven of nine patients previously had had implantation of a hip prosthesis. The interval between skin infection and surgery was 7-9 weeks in two patients and 55-520 weeks in five. No infection of the implant was evident. The assumed portals of entry were gluteal fold intertrigo, tinea pedis, psoriatic plaque and a carbuncle of the buttock. The infection was successfully treated by intravenous antibiotics and, after a follow-up of a mean 64 months, no recurrence of cellulitis has been observed and only one aseptic loosening has occurred. Infectious cellulitis of the hip or buttock following hip surgery can occur secondary to impaired lymphatic drainage, a few weeks up to several years after surgery, without there being any infection of the orthopaedic implant.

Aged↗

[The new-generation laser surgical apparatus Doktor in the combined treatment of stomatological disease in an outpatient setting].

Presents the design, technological characteristics (wavelength 10.6 mu cm, power up to 7 W, permanent mode) of a new-generation surgical laser Doktor and its use in the treatment of dental and maxillofacial diseases (diseases of the periodontium and buccal mucosa, pericoronitis, trophic ulcers, retention cysts, furuncles and carbuncles of the skin of the neck and face, odontogenic inflammatory processes, injuries, tumors) and in reconstructive, plastic, and cosmetologic surgery.

Combined Modality Therapy↗

Treatment of Staphylococcus aureus infections in children in office practice.

One hundred five Staphylococcus aureus infections occurring in 79 children who were seen in a private office practice were evaluated for response to antibiotic therapy. The value of in vitro disk susceptibility testing in directing antibiotic selection in treatment failures was also examined. Of the total episodes studied, the types of infection studied included vesicular pyoderma (48%), secondary pyoderma (13%), bullous pyoderma (5%), furunculosis (14%), carbunculosis (12%), cellulitis (3%), suppurative otitis media (4%), and paronychia (2%). Comparative treatment efficacy was obtained with perioral erythromycin estolate and erythromycin ethylsuccinate, cefaclor and cephalexin, and clindamycin hydrochloride and dicloxacillin sodium. Penicillin V potassium, ampicillin, and topical bacitracin were generally ineffective. In 23 patients, 27/105 infections were initial treatment failures. Antibiotic disk susceptibility testing predicted these clinical failures and/or the antibiotic that would produce a clinical response in 21 of these 23 patients, suggesting that this office procedure can be of considerable value.

Adolescent↗

Role of imipenem/cilastatin in the treatment of soft tissue infections.

Imipenem/cilastatin was given to 243 evaluable patients with moderately severe to severe soft tissue infections. Cultures prior to therapy yielded Staphylococcus aureus (108 isolates), group D and non-group D enterococci (49), group A streptococci (42), other aerobic gram-positive cocci (72), Pseudomonas aeruginosa (54), Escherichia coli (32), Proteus mirabilis (31), Enterobacter (21), Klebsiella (20), other aerobic gram-negative rods (58), Bacteroides fragilis group (16), and other anaerobes (65). Overall, 95 percent (230 of 243) of the patients treated had clinical cure (137 of 243) or improvement (93 of 243). Of the 506 strains of etiologic bacterial pathogens isolated from these patients and tested against imipenem, 498 (98 percent) were susceptible to the antibiotic. Many were resistant to both older and newer penicillins and cephalosporins. Serial cultures of infection sites revealed that 426 of 498 (86 percent) of pre-therapy bacterial isolates were eradicated by imipenem/cilastatin therapy. Eight of 498 etiologic pathogens (1.6 percent) acquired resistance to imipenem (seven P. aeruginosa and one enterococcus). Such resistance acquisition was associated with clinical failure in two patients. Imipenem/cilastatin appears to be a highly effective, relatively safe therapy of soft tissue infections caused by a wide variety of gram-positive and gram-negative aerobes and anaerobes, both polymicrobial and monomicrobial in nature. Imipenem/cilastatin should be considered particularly when infection by the more antibiotic-resistant of these bacteria is suspected or proved.

Abscess↗

Significance and evaluation of calcifications associated with renal masses.

Although there are numerous references in the medical literature suggesting that calification associated with renal masses is indicative of malignant disease, our recent experience with four cases emphasizes that it is not possible to predict the nature of these lesions. The significance and etiology of renal calcification are discussed as well as the indications for clinical evaluation.

Adult↗

Value of computerized tomography in evaluation of kidney.

The use of intravenous iodinated contrast material after a preliminary computerized axial tomographic scan of the kidney has been an extremely valuable adjunct in differentiating benign, malignant, and some inflammatory processes. The diagnosis of type of lesion present has been facilitated and allows direction for further diagnosis and therapy.

Carbuncle↗

Devastating scalp infections.

The treatment of scalp wounds is occasionally complicated by infection. Although infected scalp wounds are generally limited and readily treated, they can progress to devastating proportions if not promptly and aggressively managed. This report highlights three such cases of severe infection: extensive subgaleal abscess, fatal necrotizing fasciitis, and widespread carbunculosis. The authors emphasize the need for proper assessment of scalp wounds, meticulous cleansing and closure of all fresh wounds, definitive drainage of newly infected wounds, and adherence to sound surgical principles in managing these wounds.

Abscess↗

Spontaneous rupture of renal cysts into the pyelocaliceal system.

Patients with spontaneous rupture of renal cortical cysts into the pyelocalciceal system present with gross hematuria, usually associated with flank or abdominal pain. Diagnosis is established by retrograde filling of the cyst cavity with contrast material through a wide pyelocaliceal communication visualized during IVP with nephrotomography. Percutaneous renal puncture with histochemical analysis of the aspirate is indicated in certain patients for diagnostic confirmation. Renal angiography and/or an operation should be performed when the differential diagnosis remains unclear. Antibiotics in the patients with urinary tract infections along with conservative medical management is sufficient treatment, since rapid closure of the cyst-pyelocaliceal communication with cessation of hemorrhage occurs rapidly in most patients.

Adult↗