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At least 307 records · Page 17Linked to original sources

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↗