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Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch) A corrigendum to this article was published in Palliative & Supportive Care 19(3), June 2021, pp. 393. https://doi.org/10.1017/S1478951521000560, Objectives: Patients with terminal illness are at high risk of developing delirium, in particular, those with multiple predisposing and precipitating risk factors. Delirium in palliative care is largely under-researched, and few studies have systematically assessed key aspects of delirium in elderly, palliative-care patients. Methods: In this prospective, observational cohort study at a tertiary care center, 229 delirious palliative-care patients stratified by age

Background: Peritonsillar abscess (PTA) is an infectious emergency in the head and neck, and patients with end-stage renal disease (ESRD) have an immunocompromised status. However, no relevant research has focused on the ESRD–PTA relationship. This study explored PTA in ESRD patients and their prognosis. Methods: We identified 157,026 patients diagnosed as having ESRD over January 1997 to December 2013 from Taiwan’s National Health Insurance Research Database (NHIRD). Each patient with ESRD (hereafter, patients) was matched with one control without chronic kidney disease (CKD, hereafter, controls) by sex, age, urbanization level, and income. Next, PTA incidence until death or the end of 2013 was compared between the two groups, and the relative risk of PTA was analyzed using a multiple logistic regression model. Results: The patients had a significantly higher PTA incidence than did the controls (incidence rate ratio: 2.02, 95% confidence interval [CI]: 1.40–2.91, p &lt, 0.001). The Kaplan–Meier analysis revealed that the patients had a higher cumulative incidence of PTA than did the controls (p &lt, 0.001). In Cox regression analysis, the patients had nearly twofold higher PTA risk (adjusted hazard ratio [HR]: 1.98, 95% CI: 1.37–2.86, p &lt, 0.001). The between-group differences in the PTA-related hospital stay length (8.1 ± 10.3 days in patients and 5.7 ± 4.6 days in controls, p = 0.09), consequent deep-neck infection complication (4.2% in patients and 6.3% in controls, p = 0.682), and mortality (0.0% in both groups) were nonsignificant. Conclusions: Although ESRD does not predict a poor prognosis of PTA, it is an independent PTA risk factor.

Sweet's syndrome is reportedly associated with preceding nontuberculous mycobacterial infections (NTMIs). Here, we report on a systemic Mycobacterium intracellulare infection in a patient on corticoid therapy for Sweet's syndrome. Literature searches show that 69.1% of patients with Sweet's syndrome and NTMIs developed this syndrome later than NTMIs and 89.3% of them developed during the clinical course of a rapidly growing mycobacterial infection. The residual cases were associated with slow-growing mycobacteria (14.3%), but only three cases of Mycobacterium avium complex (MAC) infections before the onset of Sweet's syndrome have been reported, and all of them were caused by disseminated MAC disease. One of these cases developed during corticoid therapy for Sweet's syndrome, while another case had underlying diabetes mellitus. Hence, the occurrence of systemic MAC disease may be an inevitable consequence of long-term steroid use and underlying diseases. Literature searches also show that cervical lymphadenitis was a predominant symptom in NTMIs (90.5%). The present case did not have cervical lymphadenitis although the previously reported MAC cases did experience it. Therefore, lymphadenitis from NTMIs may be related to the pathogenesis of Sweet's syndrome. Hence, should a patient have systemic infection without lymphadenitis, it will be more difficult to clinically confirm that MAC disease is a predisposing factor for Sweet's syndrome.

International audience; The main purpose of this study is to characterize shallow and moderately deep landslide-prone materials in crystalline rocks at moderate latitudes. The procedure is based by a four-step approach coupling the geomorphological approach, the geotechnical approach and slope stability analyses based on limit equilibrium equations. Firstly, different weathering horizons were identified with different thicknesses and characteristics depending on the original lithology. These observations led to the development of a weathering model with two steps, 'a regional paleo-weathering' step and a 'geomorphological' weathering step. Secondly, conceptual models of weathered horizon thicknesses were created according to the lithological context. These models led to the identification of three major weathering types. Thirdly, slope stability models were computed for three types of weathered lithology favourable, theoretically, to slope failure (granit, micaschists, gneiss). For each case, the different models properly computed landslide occurrences and their locations for highly saturated weathered materials that corresponded to field observations. To finalize the study, a first analysis of precipitation data was carried out to define some triggering trends for slope failures in this environment. Therefore, based on this simple approach, it is possible to define some trends for shallow and moderately deep landslides in weathered crystalline environment located in moderate latitudes with Mediterranean climate. Finally, the information can be used by end-users and practitioners for public works management on these slopes.

Over the past 50 years, intentional genetic selection within the broiler industry has led to major improvements in both body weight gain (BWG) and feed conversion efficiency. Next to its economic advantages, enhancing BWG can increase the risk of metabolic and skeletal disorders. The aim of this study was to examine whether higher BWG is a predisposing factor for broiler necrotic enteritis. In this study, 300 broilers were challenged with Clostridium perfringens using a well-established, previously described challenge model. It was found that birds with higher body weight (BW) and BWG before challenge were predisposed to develop more severe necrotic enteritis lesions. After challenge, the average BWG of the birds developing mild to severe lesions dropped significantly, negatively affecting bird welfare and performance. These results show a significant interplay between BWG and the development of necrotic enteritis lesions. This raises the question whether there is a limit to broiler performance with respect to maintaining intestinal health, and whether decreasing BWG (at certain stages of the growth cycle) can be part of a plan to prevent intestinal pathology. peerReviewed

Background Interventions that promote adjuvant endocrine therapy (AET) adherence are critical to improve breast cancer survival. The development of interventions would benefit from a better understanding of the reasons for adherence and the causal relationships of determinants using theoretical or model approaches. The aim of the present study was to identify reasons for AET adherence in breast cancer patients with sequential relationships and inter-relationships. Methods A total of 210 participants with estrogen receptor positive breast cancer who received AET completed a questionnaire assessing demographic/medical, psychological, and endocrine therapy (ET)-specific factors. A descriptive analysis was performed to identify meaningful variables. Selected variables were subjected to hierarchical regression and path analyses. The path model was tested and modified based on the research framework and the results of regression weights and model fit. Results Analysis of sequential effects showed that ET-specific factors contributed the largest proportion of variance (13.4%) to predict AET adherence, followed by psychological factors (4.6%) and demographic/medical factors (3.1%). Analysis of inter-relationships showed that demographic/medical factors such as AET regimen type and cancer stage have direct effects on AET adherence, whereas psychological factors contribute indirectly through the mediating effects of ET-specific factors. Conclusion Assessments and interventions that encompass the patient’s medication beliefs, self-efficacy, and depression are needed to promote AET adherence.

Purpose Information on the clinical features of lung abscess, which is uncommon in children, at hospitalizationis helpful to anticipate the disease course and management. There is no report concerning lung abscess in Korean children. We aimed to identify the clinical characteristics of pediatric lung abscess and compare the difference between primary and secondary abscess groups. Methods The medical records of 11 lung abscess patients (7 males and 4 females) from March 1998 to August 2011 at two university hospitals were retrospectively reviewed. The clinical characteristics, symptoms, underlying disease, laboratory and radiologic findings, microbiological results, and treatments were examined. Results Six patients had underlying structural-related problems (e.g., skeletal anomalies). No immunologic or hematologic problem was recorded. The mean ages of the primary and secondary groups were 2.4 and 5.3 years, respectively, but the difference was not statistically significant. The mean length of hospital stay was similar in both groups (22.8 days vs. 21.4 days). Immunologic studies were performed in 3 patients; the results were within the normal range. Most patients had prominent leukocytosis. Seven and 4 patients had right and left lung abscess, respectively. Staphylococcus aureus, Streptococcus pneumoniae, and antimycoplasma antibodies were detected in both groups. Two patients with primary lung abscess were administered antibiotics in the absence of other procedures, while 8 underwent interventional procedures, including 5 with secondary abscess. Conclusion The most common symptoms were fever and cough. All patients in the primary group were younger than 3 years. Structural problems were dominant. Most patients required interventional procedures and antibiotics.

Majocchi's granuloma (MG) is a rare fungal infection of the dermis that is mainly caused by dermatophytes (in >= 95% of cases); the most frequently identified cause is anthropophilic Trichophyton rubrum. In the rest of the cases, the causes are non-dermatophytic fungi such as Aspergillus species. This review aimed to provide information about the current perspectives on MG regarding its clinical characteristics, predisposing factors, laboratory diagnosis, and treatment strategies. Although the lower extremities were reported to be the most common site of infection, facial involvement has been predominant in the past 5 years. Our literature research showed that the most common predisposing factor (55%) is the use of topical steroid creams without potassium hydroxide examination during treatment of erythematous squamous dermatoses. A reliable diagnosis of MG is based on histopathological examination, including fungal culture and molecular analyses. MG should be treated not only with topical agents but also with systemic antifungal agents that are continued until the lesions are completely resolved. In systemic treatment, the most preferred drug is terbinafine, because of its efficacy, side effects, and safety.

Background Information on health-seeking behavior and utilization of health facilities in slums of Addis Ababa is scarce, impeding the implementation of effective interventions. The purpose of this study is to assess the status of health facilities utilization and predictors for health-seeking behavior of mothers/caregivers of under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia. Methods A community-based cross-sectional study design was employed in five rounds of surveys in seven kebeles in slums of Addis Ababa among 472 mothers/caregivers of 472 under-five children with acute diarrhea in reference to Andersen’s behavioral model. Data were entered into EpiData Version 3.1 and analyzed using STATA Version 14.0. Descriptive statistics were used to examine patterns of health facilities utilization and multivariable logistic regression analysis was applied to identify predictors associated with health-seeking behavior. Results Most mothers/caregivers (70.8%) sought care either at home (14.2%) or health facilities (56.6%), whereas 29.2% reported that they did not seek any care. Of those who consulted health facilities, government health facilities (76.9%) were more utilized than private (18.0%) and informal (5.1%) health facilities. Nearly all (93.9%) of the mothers/caregivers using government health facilities used health centers, and of those who took their children to private health facilities (60.9%) used clinics and 26.1% used pharmacies/drug vendors. Mothers/caregivers visiting health facilities obtained mainly oral rehydration salt (ORS) (39.8%) and home-recommended fluids (HRF) (40.3%), but few of them (11.9%) obtained ORS plus zinc supplementation. Predisposing factors of literacy of mothers/caregivers (adjusted odds ratio (AOR) = 2.4; 95% CI 1.4–4.1) and occupation (AOR = 2.6; 95% CI 1.5–4.6), the enabling factors of households monthly income of 50 United States Dollars (US$) and above (AOR = 2.9; 95% CI 1.5–5.6) and availability of nearest health facilities within 15 min walking distance (AOR = 3.3; 95% CI 1.7–6.6), and the need factors of recognizing danger signs of fever (AOR = 4.3; 95% CI 2.4–7.6) and vomiting (AOR = 3.3; 95% CI 1.8–5.9) were significantly associated with health-seeking behavior. Conclusions Increasing the proximity of health facilities in slums and health education and socioeconomic development programs targeting illiterate mothers/caregivers and poor households may promote and increase health-seeking behavior and the accessibility of health facilities for the treatment of acute diarrhea in under-five children in Addis Ababa slums.

Context: Clinicians face one of the most common bacterial infections in developing countries that is urinary tract infection (UTI). Current knowledge on antimicrobial susceptibility pattern is essential for selecting appropriate therapy. Aims: In this study, we investigated the various bacteria causing UTI and determined the sensitivity and resistance of antibiotics pattern against most prevalent uropathogens isolated from patients at tertiary hospital, Al-Baha, Saudi Arabia. Settings and Design: This was a retrospective study of urine culture conducted in King Fahad Hospital at Al-Baha in Saudi Arabia. Materials and Methods: Laboratory reports and patient medical files of both inpatient and outpatient were collected between June 2017 and May 2018, targeting both male and female of age above 18 years of age, who had been treated for UTI. Results: A total of 349 patients’ urine report was studied to identify the uropathogens. Escherichia coli was the main etiologic agent in community and hospital-acquired infections. The majority of the bacteria was isolated from female (60%), whereas the remaining (40%) was from male. The most common isolates were E. coli, Klebsiella pneumoniae, Enterococcus faecalis, E. coli Extended spectrum beta-lactamases, Pseudomonas, and K. pneumoniae ESBL (these represented 37.82%, 19.20%, 10.89%, 10.32%, 6.59%, and 3.72%, of isolate, respectively). UTI due to E. coli was at a higher rate during summer than during winter. This study showed that ciprofloxacin (20.29%) and cefuroxime (16.14%) are most prescribed medications, followed by ceftriaxone (12.96%) and then tazocin (8.80%). Imipenem, meropenem, amikacin, vancomycin, tigecycline, linezolid, and colistin were highly sensitive for most types of bacteria, but gram-negative bacteria were highly resistant to ampicillin. Gram-positive bacteria showed highly resistance to cefoxitin. Conclusion: The microbial culture and sensitivity of the isolates from urine samples should be carried out as a routine before starting the antimicrobial therapy. Current knowledge of the antibiotic sensitivity/resistance patterns of uropathogens at a particular geographical region is a guiding factor for choosing an appropriate empirical antimicrobial treatment rather than following universal guidelines.

Rationale: Herpetic esophagitis (HE) is a common condition in immunosuppressed patients, but a rare entity in immunocompetent patients affecting especially male teenagers and young adults. Patient concerns: We report the case of a 5-year-old male patient, with a history of allergic rhinitis admitted in our clinic for acute onset fever refractory to antipyretics, chest pain, anorexia, refusal of solid food, accepting only small amounts of fluids, odynophagia, and epigastric pain. The clinical exam revealed severe malaise, pallor, decreased skin turgor, abdominal epigastric tenderness, heartburn at palpation within the epigastric area. The laboratory tests showed leukocytosis, monocytosis, hypoglycaemia, and elevated inflammatory biomarkers. Diagnoses: The serology tests for human immunodeficiency virus (HIV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV) were negative, except for immunoglobulin G (IgG) anti-EBV which was positive. The chest radiography was normal, and the abdominal ultrasound showed abdominal bloating. The upper digestive endoscopy revealed friable esophageal mucosa, with multiple ulceration on the entire esophagus, and whitish exudates especially on the middle and lower part of the esophagus suggesting a possible eosinophilic esophagitis or caused by Candida. Despite the empirical initiated treatment, the patient's evolution was only slowly favorable. The histological exam established the diagnosis of HE. Interventions: We initiated acyclovir therapy with an outstandingly favorable evolution. Outcomes: After 1 month, we detected the seroconversion of IgG anti-HSV. The patient's follow-up revealed no additional complaints. Lessons: Despite its rarity in immunocompetent individuals, HE must be taken into account even in otherwise healthy small children. Allergic conditions might represent a predisposing factor for HE.

Objective: To investigate the predisposing risk factors in the occurrence of complications after vaginal hysterectomy. Material and methods: The data obtained from 223 patients, admitted to tertiary care center that underwent vaginal hysterectomy due to benign pathology between January 2006 and March 2012 were retrospectively analyzed.Chisquare test was used to evaluate variables in categorized groups. Results: Group variables occurred age, number of pregnancies and abortion, parity, stage according to pelvic organ prolapse classification (POP-Q), periods of hospitalization and urinary catheterization. The main complications were hemorrhage, febrile morbidity and vaginal vault prolapse. Advanced age (> 60), pelvic prolapse, long-term hospitalization and urinary catheterization, were predisposing factors for the presence of complications. Conclusion: Vaginal hysterectomy is a safe and effective method, although not completely devoid of intraoperative or postoperative complications. Advanced age (> 60), POP-Q stage 3-4 pelvic prolapse, prolonged hospitalization and urinary catheterization were seem to be predisposing conditions for the existence of complications. Appropriate preoperative planning and meticulous postoperative care may be helpful to reduce the rate of complications.

We report here a case of oral myiasis in the Republic of Korea. The patient was a 37-year-old man with a 30-year history of Becker's muscular dystrophy. He was intubated due to dyspnea 8 days prior to admission to an intensive care unit (ICU). A few hours after the ICU admission, 43 fly larvae were found during suction of the oral cavity. All maggots were identified as the third instars of Lucilia sericata (Diptera: Calliphoridae) by morphology. We discussed on the characteristics of myiasis acquired in Korea, including the infection risk and predisposing factors.

Objective To report our experience with Fournier's Gangrene (FG) over the past eight years and evaluate the predisposing factors which affect the mortality. Methods Sixty-five patients who were admitted to emergency surgical unit of our institution presenting with FG between January 2006 and August 2014 were included. The anatomical site of infective gangrene, predisposing factors, etiological factors, and outcomes were retrospectively reviewed. Results Our cases included 8 women and 57 men. The average age of men was 51±13.9 (range 19-75) and the average age of women was 63±10.5 (range 52-76). Average hospitalization time was 9.2±6.6 days (range 5-25) days. The most frequent comorbid disease was diabetes mellitus and the most frequent etiology was perianal abscess. Colostomy was performed in 11 patients, orchidectomy in two patients, cystostomy in two patients. Notably, all of the 8 (12.3%) patients who died from FG had diabetes and low socioeconomic status. A total of six patients who died required more than one surgical debridement. Conclusions Fournier's gangrene is a severe surgical emergency, with a high mortality rate. Low socioeconomic status, diabetes and more than one debridement play a major role in mortality and morbidity.

Bladder stones account for 5% of all urinary tract’s stone diseases. They are usually seen in older men because of infravesical obstructions such as prostate hyperplasia and neurogenic voiding dysfunction. Infection, foreign bodies, anti-incontinence surgery in woman can also be predisposing factors for bladder calculus. They can rarely be seen in children and young, healthy patients without any predisposing factors and are then called “endemic bladder calculi”. In this case report we present a 43 year old woman who has had an endemic giant bladder calculus and on whom we performed percutaneous cystolithotomy. The stone measured 61x56 mm in size. It was composed of calcium oxalate. In our patient, despite all the researches there was no etiological cause but the patient, had used herbal pills that came from China. The aim of this case report is to emphasize the fact that bladder calculi can develop in middle-aged patients without any predisposing factors.

Infectious bovine keratoconjunctivitis (IBK) is an acute disease caused by Moraxella bovis (Mb). Several factors may predispose animals to an IBK outbreak; one commonly observed is infection with bovine herpes virus type 1 (BHV-1). The aim of this study was to investigate the dynamics of BHV-1 virus infection and its relation with clinical cases of IBK in weaned calves from a beef herd with a high prevalence of lesions caused by Mb. Sampling was carried out in six stages and included conjunctival swabs for isolating Mb as well as blood samples for identifying antibodies specific for BHV-1. A score for IBK lesions after observing each eye was determined. The findings of this study showed a high prevalence of BHV-1 virus infection (100% of animals were infected at the end of the trial); 67% of animals were culture-positive for Mb, but low rates of clinical IBK (19% of calves affected) were detected at the end of the trial. These results suggest that infection with BHV-1 did not predispose these animals to IBK, and that Mb infection produced clinical and subclinical disease in the absence of BHV-1 co-infection.

Purpose The aim of this study was to examine the recent status of intraocular lens (IOL) dislocation according to a classification system based on vertical dislocation position, as well as the surgical techniques and outcomes of IOL exchange surgery. Methods The medical records of 230 eyes from 214 consecutive patients who experienced IOL dislocation and underwent exchange surgery between 2006 and 2014 were reviewed. Vertical dislocation sites observed preoperatively under operating microscopy were examined, along with the surgical techniques and outcomes of IOL exchange. Results Dislocation sites included (1) the anterior chamber (12.2 %), (2) pseudophakodonesis (19.1 %), (3) the anterior vitreous cavity (47.4 %), (4) trap door-like dislocation (dangling in the peripheral vitreous cavity; 16.1 %), and (5) the retinal surface (5.2 %). The IOL retained in the anterior segment was moved onto the iris by pulling it up through the limbal side ports with an anterior vitrectomy (67.8 %), or by pushing it up from the pars plana with an anterior vitrectomy (26.5 %), while the IOL dropped on the retina was lifting it up from the retina after pars plana vitrectomy (5.7 %). Mean uncorrected and distance-corrected visual acuity significantly improved postoperatively (p

The study was carried out to discover the effects of the oral intake of some soft drinks (Fanta, Sprite, Fayrouz, Coca-cola and Schweppes) on blood glucose level and lipid profile of albino rats. The rats were grouped into 6 each containing 4 rats, and were allowed to fast for 12hrs, their fasting blood glucose was taken to know their pre treatment fasting blood glucose level. Group 1 was administered with normal saline, group 2 was given Fanta, group 3 was given Sprite, group 4 was given Schweppes, group 5 was given Fayrouz and group 6 was given Coca-cola. All the groups were administered with 3ml of the soft drink per 100g body weight twice a day respectively throughout the period of the research. The research lasted for 14 days. On the last day the rats were allowed to fast again for a period of 12hrs after which the fasting blood glucose level was determined; finally, the rats were sacrificed by cervical decapitation and the serum collected for the determination of lipid profile. There was statistical difference (pRead Complete Article at ijSciences: V3201405454

The most common mononeuropathy in the lower extremity involves the nerve. We retrospectively evaluated the etiological predisposing factors and clinical-neurophysiological features of 36 patients affected by peroneal mononeuropathy (PM). In 30 patients, a clear predisposing factor was identified. PM was more frequently perioperative (11 cases), associated with axonal involvement. Unexpectedly, PM was not only due to surgery close to the peroneal region, but was mostly associated with hip surgery and, rarely, with thoracic-abdominal surgery. A postural predisposing factor of PM was also frequently observed, usually associated with a pure conduction block. Conversely, most patients with bedridden predisposing factor presented axonal involvement, which was rarely associated with conduction block. In 25 of 36 PM cases, a long-term follow-up lead to an improvement (12 cases) or to good recovery (13 cases) of PM. In conclusion, our study shows that: (1) in most PM cases it is possible to identify a predisposing factor; (2) there is a good correlation between predisposing factor and neurophysiological involvement, and (3) PM usually has usually a good prognosis.

Superior mesenteric artery (SMA) syndrome is a relatively rare disease, which is caused by the obstruction of the third portion of the duodenum due to extrinsic compression by the SMA and the abdominal aorta. Although anatomical characteristics, such as the acute angle of the SMA to the abdominal aorta and proximity of the SMA to the abdominal aorta, are considered as underlying factors for causing SMA syndrome, most cases occur with predisposing factors such as rapid body weight loss and rapid growth. We recently experienced a case of SMA syndrome that had occurred without any considerable predisposing factors. The patient was a 17-year-old female, who had neither lost weight nor experienced recent increase in height. ' She was also stable psychosomatically and had not been taking a slimming diet. She suddenly started vomiting shortly after meals and lost 4 kg in weight over 10 days. Although gastrointestinal fiberscopy did not show significant findings, upper gastrointestinal X-ray series revealed a sharp cut-off and obstruction to the passage of barium in the third portion of the duodenum. This obstruction was restored in a prone position. Subsequent magnetic resonance images did not show any tumorous lesions in the abdomen, resulting in the diagnosis of SMA syndrome. She recovered from the symptom by taking a prone position after meals. SMA syndrome caused without predispos- ing factors is considered to be a rare case and the related literature is reviewed.

Patellofemoral pain syndrome (PFPS) is a very common disorder of the knee. Due to multiple forces influencing the patellofemoral joint, clinical management of this ailment is particularly intricate. Patellofemoral pain syndrome has a multifactorial nature and multiple parameters have been proposed as potential risk factors, classified as intrinsic or extrinsic. Some of the intrinsic risk factors are modifiable and may be approached in treatment. A number of modifiable risk factors have been suggested, including quadriceps weakness, tightness of hamstring, iliopsoas and gastrosoleus muscles, hip muscles dysfunction, foot overpronation, tightness of iliotibial band, generalised joint laxity, limb length discrepancy, patellar malalignment and hypermobility. In general, the routine approach of physicians to this problem does not include assessment and modification of these risk factors and therefore, it may negatively affect the management outcomes. Changing this approach necessitates an easy and practical protocol for assessment of modifiable risk factors and effective and feasible measures to address them. In this review, we aimed to introduce assessment and intervention packages appropriate for this purpose.

Infection with mediastinitis after cardiac or aortic aneurysm surgery has been a serious complication with high mortality. Between January 1993 and December 1994, of 274 patients who underwent cardiac or thoracic aortic aneurysm surgery, 10 patients (3.6%) developed serious infection with mediastinitis. Most of these patients with infection were associated with predisposing factors: advanced age, diabetes mellitus or respiratory insufficiency. In four patients, the infection was successfully treated with omental transposition into the mediastinum five to twelve months after the first operation. The remaining six patients died of infection or multi-organ failures three to twelve months after the surgery. We conclude that much clear operation should be kept during surgery and indication for the operation in the patients with predisposing factors should be much severe., 論文

Infection with mediastinitis after cardiac or aortic aneurysm surgery has been a serious complication with high mortality. Between January 1993 and December 1994, of 274 patients who underwent cardiac or thoracic aortic aneurysm surgery, 10 patients (3.6%) developed serious infection with mediastinitis. Most of these patients with infection were associated with predisposing factors: advanced age, diabetes mellitus or respiratory insufficiency. In four patients, the infection was successfully treated with omental transposition into the mediastinum five to twelve months after the first operation. The remaining six patients died of infection or multi-organ failures three to twelve months after the surgery. We conclude that much clear operation should be kept during surgery and indication for the operation in the patients with predisposing factors should be much severe.

Yoshihiko Oono, Koji Uehara, Masatoshi Haruta, Ryoji YamakawaDepartment of Ophthalmology, Kurume University School of Medicine, Kurume, JapanPurpose: To describe the characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment.Methods: A retrospective study of pediatric patients (15 years old or younger) who had undergone primary surgery for rhegmatogenous retinal detachment was conducted. Patients were divided into five groups according to the predisposing factors: trauma (group 1), myopia (group 2), atopic dermatitis (group 3), congenital or developmental anomalies (group 4), and others (group 5).Results: A total of 48 eyes of 44 patients were included in this study. There were 18 eyes (37.5%) in group 1, twelve eyes (25.0%) in group 2, six eyes (12.5%) in group 3, five eyes (10.4%) in group 4, and seven eyes (14.6%) in group 5. The initial retinal reattachment rate was 89% in group 1, 100% in group 2, 83% in group 3, 20% in group 4, and 86% in group 5 (P = 0.002). The final retinal reattachment rate was 100% in group 1, 100% in group 2, 100% in group 3, 80% in group 4, and 86% in group 5 (P = 0.16). The frequency of visual acuity of 0.1 or better after surgery was 100% in group 1, 92% in group 2, 83% in group 3, 40% in group 4, and 71% in group 5 (P = 0.01).Conclusion: The overall surgical outcome was successful, but the patients in group 4 had the lowest initial reattachment rate and the worst visual prognosis.Keywords: children, detached retina, surgical outcome, predisposing factor

Microbial (non-viral) keratitis is a serious vision-threatening condition. The management of microbial keratitis in children is particularly complicated by the children’s inability to cooperate during examinations and the lack of information prior to presentation. Predisposing factors vary according to geographical location and age. Corneal trauma is the leading cause for microbial keratitis in children, followed by systemic and ocular disease. Etiologic agents are most frequently Gram-positive and Gram-negative bacteria commonly found in contact lens-related microbial keratitis. Mycotic keratitis is a major risk factor in tropical weather conditions, particularly when associated with agricultural trauma. Early diagnosis, intensive drug treatment, and timely planned surgical intervention may effectively improve the outcome of pediatric microbial keratitis.

1989年3月31日までの1年間に, 受診した499例について, 1)患者の年齢分布は3歳～88歳(平均年齢43歳)で, 20歳代が24%を占め最も多かったが, 30歳代から60歳代にかけても14～16%の年齢分布を示した.2)尿からの分離菌種はE. coliが圧倒的に多く(81%), ついで各種のStaphylococcus spp. (11%)が多かった.Staphylococcus spp.は夏期に多く分離される傾向があった.3)臨床症状として80%以上の症例が排尿痛, 残尿感, 頻尿を訴え, 初発症状として最も多いのは排尿痛(39%)であった.4)患者の訴えによる膀胱炎発症の誘因としては, 過労(131例), 排尿我慢(114例), 冷え(103例)が多く, 性交渉が発症誘因と回答したのは42例であった.5)「新婚膀胱炎」を経験した患者群は, 経験しない患者群に比べて, 最近3年以内の膀胱炎罹患率が有意に高かった, A total of 499 female patients with acute uncomplicated cystitis were observed and analyzed clinically for age distribution, characteristics of symptoms, bacterial culture of urine, behavioral aspects of recurrent cystitis and others. The patients were between 3 years and 88 years old (average: 43 years) and the majority of patients were from 20 to 69 years old. From 81.1% of the patients Escherichia coli was detected, followed by Staphylococcus spp (11.2%). The major symptoms were pain on urination (421 cases), urinary frequency (421 cases) and residual urine sensation (418 cases). The major causes of cystitis as reported by the patient were fatigue (131 cases), infrequent voiding (114 cases) and exposing the body to coldness (103); only 42 patients reported a relationship between sexual intercourse and cystitis. The patients who had been suffering from "honeymoon cystitis" were significantly inclined to be suffering from acute uncomplicated cystitis again in comparison with those who had not suffered from honeymoon cystitis. There was suggested to be a relationship between sexual intercourse and recurrent cystitis.