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Biomedical subjects

M Schurr

Publications and source records attributed to M Schurr.

9 recordsLinked to original sources
PubMed1998

Fungal sacral osteomyelitis as the initial presentation of Crohn's disease of the small bowel: report of a case.

We report a unique case of Candida albicans sacral osteomyelitis in a 48 year-old female with previously undiagnosed Crohn's disease. The patient was ill for one year with fatigue, weakness, and a 60-lb weight loss. At the time of presentation, she developed chills, fever, right lower quadrant abdominal pain, and right knee pain. Physical examination was significant for a palpable right lower quadrant abdominal mass. A computed tomographic scan of the abdomen and pelvis identified a large right-sided retroperitoneal mass, severe right hydronephrosis, and air within the right sacrum. Findings at laparotomy included small-bowel changes consistent with Crohn's disease, a multiloculated retroperitoneal abscess, and evidence of sacral osteomyelitis. A right hemicolectomy with sacral debridement and placement of presacral drains was performed. Bone cultures from the sacrum demonstrated a predominance of C. albicans, in addition to coliforms and enterococcus. The patient was placed on amphotericin B and intravenous antibiotics. Because serial computed tomographic scans of her pelvis demonstrated progression of her pelvic osteomyelitis to include the sacrum, right ilium, right acetabulum, and right femoral head, a repeat debridement with resection of the right femoral head was performed. After 12 months of follow-up, she was doing well without medications and had no constitutional symptoms or radiographic evidence of disease progression. This report illustrates a unique case of Crohn's disease presenting as sacral osteomyelitis secondary to small-bowel fistulization. Aggressive multidisciplinary surgical and medical management were the key to the successful management of this difficult case.

Abscess↗
PubMed1998

Limb salvage for streptococcal gangrene of the extremity.

BACKGROUND: Extremity soft tissue infections from group A, beta-hemolytic streptococcus frequently culminate in amputation. This study compares our protocol for limb salvage with expected results. METHODS: Patients with extremity streptococcal gangrene treated from 1989 to 1995 were reviewed. The management protocol mandated immediate, radical excision of involved skin and subcutaneous tissue, with preservation of fascia. Patients were managed in the burn unit, and wounds were covered with split-thickness skin grafts. Amputation rate and mortality were measured. RESULTS: Fourteen cases of extremity streptococcal gangrene were identified. Delay to surgical referral was 5 days. Eleven (79%) patients were septic. Ten (71%) were managed with a single debridement before grafting. Limb salvage was 93% (13 of 14). One patient (7%) died on day 150 from acute myelogenous leukemia. CONCLUSIONS: Delay in referral of extremity streptococcal gangrene is common, contributing to a high incidence of sepsis. Our management protocol of a single, radical debridement with preservation of fascia maximizes limb salvage and survival.

Adult↗
PubMed1998

Traumatic asphyxia following stadium crowd surge: stadium factors affecting outcome.

BACKGROUND: Stadium crowd surges frequently occur following major athletic events. A recent crowd surge injured more than 80 persons by trampling and/or crushing. This incident was reviewed to identify injury patterns consistent with crush-related injury. In addition, the incident was reviewed to determine which stadium policy and design factors may have potentiated this event. METHODS: A recent crowd surge occurred following a college football game. This resulted in 86 people being transported to the University of Wisconsin and other area hospitals. All charts were reviewed to evaluate patient outcomes. The stadium was examined as were security system video tapes to evaluate stadium factors that contributed to this event. Current policies were obtained through the university sports administration. RESULTS: Of 86 patients transported for evaluation of stadium-related injuries, 10 were treated for traumatic asphyxia. Other injuries requiring hospital admission included musculo-skeletal trauma in two patients and one grade II liver injury. Six others were admitted overnight for observation. Several stadium factors were identified that contributed to the event, and appropriate changes in crowd control policies and stadium design were instated to prevent recurrence. CONCLUSIONS: This report details the largest single report of traumatic asphyxia second to the England Hillsborough disaster. Several stadium factors were identified that resulted in crush-related injury. Cooperative review and modification of stadium policies and design may prevent such events in the future.

Adolescent↗
PubMed1997

Predicting clinical outcome of nonsurgical management of blunt splenic injury: using CT to reveal abnormalities of splenic vasculature.

OBJECTIVE: Using CT to grade blunt splenic injuries frequently does not predict clinical outcome. This retrospective, blinded study evaluated whether revealing a traumatic pseudoaneurysm or frank hemorrhage on an initial CT examination can be used to predict the successful clinical outcome of patients managed without surgery. MATERIALS AND METHODS: The medical and CT records of all patients with blunt splenic injury during a 5-year period were independently reviewed for vascular abnormalities. Also, the grade of injury was reconfirmed. Hemodynamically stable patients with injuries of grades 1-3 were managed without surgery. Clinical failure occurred if a patient required splenectomy or splenorrhaphy after any attempt of nonsurgical management. RESULTS: Two hundred sixty-three patients were treated for blunt splenic injuries. Eighty-two of these patients underwent emergent surgery on the basis of clinical and peritoneal lavage findings without CT examination. The remaining 181 (69%) patients were initially evaluated with emergent abdominal CT. Of these 181 patients, 72 (40% of those undergoing CT) were treated nonsurgically. Nonsurgical therapy failed in 11 (15%) of these 72 patients. Of these 11 patients, nine (82%) had a defined vascular abnormality of the spleen. Only eight (13%) of the remaining 61 patients who underwent CT and successful nonsurgical management had a vascular abnormality of the spleen. CONCLUSION: The failure rate in patients with nonsurgically managed blunt splenic injuries may be markedly reduced if patients with traumatic pseudoaneurysm or active hemorrhage revealed on emergent CT are treated with early surgical or endovascular repair.

Adult↗
PubMed1996

Paradoxical bullet embolism: case report and literature review.

Bullet embolization through the arterial or venous systems, although unusual, often causes diagnostic confusion. Paradoxical emboli are even more unusual. We present a case of a paradoxical bullet embolism from the left external iliac vein to the left common iliac artery via a patent foramen ovale.

Adult↗