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Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Jocelyn A. Luongo, Boris Shapiro, Orlando A. Ortiz, Douglas S. Katz
The iliopsoas compartment is located between the spine and the retroperitoneal organs and constitutes an important anatomic conduit of disease from the thorax to the pelvis and proximal femur. Diseases of the psoas often present with vague abdominal complaints, with painful hip flexion deformity present in less than half of patients. Psoas abscess is defined as primary when there is no local cause identified, and it is then usually attributed to hematogenous spread of a distant, and sometimes occult, infectious process. It is associated with immunosuppression, diabetes, and/or drug abuse. The most common causative pathogen is S. aureus. Secondary psoas abscess is more common in immunocompetent patients and is due to local infectious spread from the intestines, kidneys, or bone. It is usually polymicrobial. Fistulizing Crohn disease is reportedly the most common cause. Iatrogenic causes of psoas abscess include urologic surgeries and surgeries on the lumbar or hip areas. Underlying retroperitoneal space malignancy is a very rare cause of secondary psoas abscess [16,17].
Small Bowel Crohn’s Disease
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Barry Salky, Naif Alenazi, André D’Hoore, Michael R.B. Keighley
There are two ways to mobilise the mesentery in laparoscopic surgery: medial-to-lateral or lateral-to-medial. Both techniques are based on the embryology of the mesentery.29 Both techniques are acceptable, but the author prefers a medial-to-lateral approach. There are reasons why surgeons should be familiar with both approaches. In the medial approach, dividing the ileocolic vessels provides access to the plane between the retroperitoneum and the mesentery. In order to do that, there has to be appropriate traction of the mesentery. When traction is applied, the ileocolic vessels are easily seen identified with visualisation of the second portion of the duodenum. If there is a fistula that cannot be taken down laparoscopically first, then a lateral to medial approach is easier and safer. If there is a large phlegmon attached to the mesentery or to the retroperitoneum, appropriate identification of the ileocolic vessels may be difficult. Therefore, a lateral to medial approach under the circumstances would be a better option. If there is an ileo-psoas abscess, the medial to lateral approach is definitely more difficult. Thus, knowledge of both approaches is useful in this complex surgery.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
An abscess is a localised tissue collection of pus, surrounded by a ‘pyogenic membrane’, which itself is not a true membrane, rather a wall of fibrin, capillaries, neutrophils, and fibroblasts. Pus contains a mixture of dead and live neutrophils, fibrin, lipid, coagulation, and complement factors. A pre-existing pilonidal sinus gives rise to a pilonidal abscess; coliforms are the most frequently implicated organism. A psoas abscess is most frequently caused by S. aureus, tuberculosis, and other rare microorganisms. A sterile abscess is defined as an abscess devoid of microorganisms; this may occur following sterilisation of a septic abscess (i.e., with antibiotics), or following intramuscular injection of paraldehyde.
Accuracy of gradient diffusion method for susceptibility testing of dalbavancin and comparators
Published in Expert Review of Anti-infective Therapy, 2022
A. G. Leroy, V. Lavigne-Quilichini, P. Le Turnier, B. Loufti, E. Le Breton, C. Piau, M. Kempf, A. Pantel, M. Amara, C. Neuwirth, R. Sanchez, J. Guinard, J. F. Huon, M. Grégoire, S. Corvec
Sixty-eight patients met the inclusion criteria during the study period. Among them, 93 strains were isolated, all responsible for an infection (coagulase negative staphylococci (CoNS) were included only if the same organism was isolated from 2 or more samples), including 41 monomicrobial infections and 27 polymicrobial infections. The species were distributed as follows: 31 Staphylococcus aureus, 34 S. epidermidis, 5 S. haemolyticus, 4 S. lugdunensis, 2 S. caprae, 1 S. hominis, 1 S. capitis, 1 S. pettenkoferi, 8 Enterococcus faecalis, 4 E. faecium, 1 E. avium, and 1 E. durans. They were isolated from bone/tissues or biopsies (n = 63), blood cultures (n = 23), deep abscess (n = 2), cardiac devices (n = 2) and joint fluid (n = 3). More specifically, included CoNS were responsible for bone and joint infections (with or without prosthesis) (n = 38), bacteremia (n = 7), infective endocarditis (n = 2) and deep psoas abscess (n = 1). By BMD, 91/93 (97.8%), 93/93 (100%), 91/93 (97.8%), and 81/93 (87.1%) isolates were susceptible to dalbavancin, daptomycin, vancomycin, and teicoplanin, respectively.
Richard Bright’s observations on diseases of the nervous system due to inflammation
Published in Journal of the History of the Neurosciences, 2018
Case 70 (Bright, 1931, p. 138) is unusual in that the purulent meningitis originated in a psoas abscess. Bright believed “a connection existed between the psoas abscess and the spinal cord by the openings through which the nerves made their exit from the spine,” which he believed to be the path by which the pus entered from the abscess into the spinal canal, but he had trouble grasping how pus “could effuse itself so generally over the surface of both hemispheres” (p. 140).
Q fever vertebral osteomyelitis among adults: a case series and literature review
Published in Infectious Diseases, 2021
Nesrin Ghanem-Zoubi, Tony Karram, Olga Kagna, Goni Merhav, Zohar Keidar, Mical Paul
A 66 years old male was hospitalized to investigate weakness and weight loss lasting for two months. Comorbidities included hypertension, smoking, coronary artery disease, chronic kidney disease, an AAA known for 18 months and a history of coronary artery bypass grafting performed 9 years before admission. His physical examination was unremarkable. Laboratory tests showed mildly elevated CRP (1.85 mg/dl) and creatinine 1.6 mg/dl. A complete blood count was within the normal limits. Serum protein was 8.3 gr/dl, albumin 4.2 gr/dl and calcium 10.5 mg/dl. Protein electrophoresis showed hypergammaglobulinemia (21.6%) with a negative Bence Jones fraction in the urine. Liver enzymes were mildly elevated (1–1.5 folds of upper normal limit). Abdominal ultrasonography showed a hypo-echogenic mass surrounding the aorta proximal to the bifurcation. CT angiography identified a retroperitoneal collection involving the posterior wall of the aorta and the left psoas muscle causing destruction of the anterior part of L5 vertebral body. In addition, focal dilatation of the aorta with irregularity of the lateral wall was seen. Multiple blood cultures were negative as well as Brucella serology. A percutaneous puncture of the psoas abscess yielded a small amount of cloudy fluid. Culture and 16S rRNA and C. burnettii PCR were negative. Q fever serology yielded a phase I IgG of 12800 and phase II IgG of 200 compatible with chronic Q fever infection. PCR for C. burnettii in blood was not performed. Echocardiography showed no vegetations. The patient underwent open surgical debridement of the involved part of the aorta and in-situ aorto-iliac graft insertion. On surgery, a large amount of pus was observed as well as a thrombus in the false lumen of the aneurysm. Histology showed fragments of fibrin with reactive lymph nodes. Culture taken during surgery were positive for Staphylococcus warneri in one swab out of several samples taken. Tissue 16S rRNA was negative but an in-house real-time PCR targeting C. burnettii was positive. The patient was diagnosed with chronic Q fever causing vascular infection and vertebral osteomyelitis and started treatment with doxycycline and hydroxychloroquine (Table 1). Hydroxyychloroquine was switched to levofloxacin due to intolerance and severe nausea. He was discharged recently with a plan of 18 to 24 months of treatment. In his last follow up of 6 months, he felt well.