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Qualls E J Stevens Jason M Seibly Ying H Chen Rob D Dickerman Jerry Noel Keith A Kattner 《Journal of clinical neuroscience》2007,14(6):585-589
The adequate treatment of methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis has intrigued clinicians for some time. As the resistance of these pathogens, coupled with the increase in community-acquired cases, continues steadily to rise, clinicians are finding it useful to employ multi-modal approaches for efficacious treatment. The authors present a single case report of a patient with recurrent MRSA osteomyelitis, lumbar paraspinal and epidural abscess. He was found to have decreased muscle strength and was hyporeflexic in the involved extremity. Serum testing demonstrated MRSA bacteremia. Neuroimaging studies revealed evidence of paraspinal abscess and a presumed herniated nucleus pulposus at the L5/S1 interspace with significant nerve root compromise. Despite antimicrobials, his symptoms persisted, necessitating surgical exploration. At surgery, paraspinal and epidural abscesses were encountered and debrided; however, no herniated disc was visualized. This case demonstrates the diagnostic and therapeutic dilemmas with which these lesions present. We postulate that the MRSA osteomyelitis/discitis pathogens were walled off in the disc space and subsequently inoculated the soft tissues with ensuing bacteremia. We concur that antimicrobial treatment should be the first line of therapy for these patients; however, surgical debridements and cautious spinal instrumentation should be employed where appropriate. 相似文献
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C A Soutar W M Maclaren R Annis A W Melville 《British journal of industrial medicine》1986,43(1):29-36
Present estimates of the quantitative relations between exposure to mixed respirable coalmine dust and risk of developing coalworkes' simple pneumoconiosis are based on studies of working miners. These studies did not include men who had been miners but had left the coal industry, and it was not known whether the estimates of risk were also appropriate for these men. The results are reported of a study in which the dust/disease relations in men who have been miners but have left the industry have been compared with those in men who have remained in it. A sample of 17738 men who were first examined when working in 24 British collieries in the 1950s has been followed up about 22 years later. It was possible to examine 61% of the survivors, 44% of the original sample. Simple pneumoconiosis was more frequent among men (particularly older men) who had left the industry than among those who had stayed in it. A detailed analysis did not show any systematic or statistically significant difference between men who stayed and men who left in the quantitative relations between dust exposure and simple pneumoconiosis. Present estimates of risk of simple pneumoconiosis in relation to exposure to mixed respirable dust in working miners adequately describe the relation found in men who have been miners but have left the industry. 相似文献
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While two prophylactic HPV vaccines have been proven notably efficacious in clinical trials, the effectiveness of these vaccines at the population level remains to be evaluated. To lay the foundation for understanding the strengths and limitations of different endpoints for future effectiveness research, we present a comprehensive review of HPV-related clinical outcomes, including: (i) HPV type-specific positivity and persistence, (ii) Pap diagnoses (ASC-US, LSIL, and HSIL), (iii) histologic cervical cancer precursor lesions (i.e., CIN1, CIN2, and CIN3), (iv) invasive cervical cancer (ICC), (v) anogenital warts, (vi) recurrent respiratory papillomatosis (RRP), and (vii) other HPV-associated cancers (vulvar, vaginal, anal, penile, and oropharyngeal). While research on the vaccines’ effects on these HPV clinical outcomes in the general population is presently limited, numerous large trials will soon be completed, making a priori discussion of these potential outcomes especially urgent. Furthermore, population level systems to track HPV-associated clinical outcomes may need to be developed for HPV vaccine effectiveness evaluation. 相似文献
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Noel R. Fajardo Filippo Cremonini Dr Nicholas J. Talley 《American Journal of Cancer》2006,5(5):319-330
In patients with cancer, constipation is a common complication. However, unlike in the general population, the impact of the symptoms of constipation on the quality of life in cancer patients is often greater. More importantly, in patients who are in the more advanced stages of the disease, constipation may also be suggestive of disease progression. Constipation as a symptom in this population is of significant importance as it may lead to life-threatening complications, i.e. bowel perforation due to fecal impaction. Therefore, in this regard, this problem deserves particular attention, as early recognition and management of complications may prevent further physical deterioration. This review aims to provide an overview of the management of constipation in patients with cancer. A symptom-based criteria definition for chronic constipation and prevalence of the problem in cancer patients provides a brief introduction. For the initial assessment and evaluation of constipation in cancer patients, an algorithm is described. The different possible etiologies of constipation in cancer patients are also discussed. Regarding therapeutic management, guidelines and recommendations for the use of different types of laxatives, stool softeners, suppositories and rectal enemas, prokinetic agents, antidepressant medications, and miscellaneous agents are succinctly discussed. Management of fecal impaction and opioid-induced bowel dysfunction are also described. Lastly, a brief overview of the management of acute colonic pseudo-obstruction and surgical or endoscopic options for large bowel obstruction are described. 相似文献
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