Delaware medical journal最新文献_第5页

Immunomodulatory Therapy and an Insidious Presentation of a Large Intra-Abdominal Abscess. 免疫调节疗法与腹腔内大脓肿的隐伏表现。

Delaware medical journal Pub Date : 2016-09-01 DOI: 10.14309/00000434-201610001-02667

Emily Au, Ahmad M. Al-Taee, M. Hammami

{"title":"Immunomodulatory Therapy and an Insidious Presentation of a Large Intra-Abdominal Abscess.","authors":"Emily Au, Ahmad M. Al-Taee, M. Hammami","doi":"10.14309/00000434-201610001-02667","DOIUrl":"https://doi.org/10.14309/00000434-201610001-02667","url":null,"abstract":"Crohn's disease is a disorder characterized by transmural inflammation which can potentially affect any part of the gastrointestinal tract from the mouth to the perianal area. Cohn's disease is a systemic disease characterized by a relapsing remitting course, with variable intestinal and extra-intestinal complications. Abdominal and pelvic abscesses are not an uncommon complication of Crohn's disease occurring in 10-30 percent of all patients. We present the case of a 21-year-old male with Crohn's disease presenting with a massive abdominal abscess, whose diagnosis was delayed given lack of typical symptoms. Shortly after initiating therapy with Prednisone and Adalimumab he presented with worsening abdominal distention. Cross sectional imaging of the abdomen with IV contrast (Figure 1) demonstrated a 34cm x 23 cm x 11 cm rim-enhancing fluid collections in the abdomen and pelvis consistent with a large intra-abdominal abscess. He underwent an exploratory laparotomy, abdominal washout, and wound vacuum placement. Five liters of purulent fluid were aspirated and cultures grew citrobacter, veillonella and candida glabrata.\u0000A bowel perforation was suspected as the etiology for abscess formation; however magnetic resonance heterography (Figure2) was unremarkable. He was treated with appropriate antibiotics, antifungal agents, and was started on Aprisa. His course was complicated with recurrence of intra-abdominal abscesses and a colocutaneous fistula for which he underwent an open sigmoidectomy with a diverting loop colostomy. After condirmation of healing with repeat imaging, he was an uneventful postoperative course. He followed as an outpatient and continues to do well on Infliximab.\u0000Most abscesses are picked up in their early stages given characteristic symptoms; however in presence of immunosuppressive therapy the host immune system can be suppressed leading to delayed diagnosis. The presence of a massive intra-abdominal purulent fluid collection of this size has not been described on our review of the literature. Furthermore, despite the abscess taking up most of the abdominal cavity, the fairly limited symptom burden highlights the importance of having high degree of clinical suspicion for infectious compications in Crohn's disease patients even when classical symptoms are not present.","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"88 9 1","pages":"280-2"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67079699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Successful Percutaneous Transcatheter Patent Foramen Ovale Closure Through The Right Internal Jugular Vein Using Stiff Amplatzer Catheter With A Reshaped Tip. 应用尖端改良的硬质安铂氏导管经右颈内静脉成功闭合卵圆孔未闭。

Delaware medical journal Pub Date : 2016-08-01

Zaher Fanari, Sumaya Hammami, James T Hopkins

引用次数: 0

Intubation Barotrauma and/or CPR Causing Tension Pneumoperitoneum. 插管气压创伤和/或心肺复苏术引起紧张气腹。

Delaware medical journal Pub Date : 2016-07-01

Elizabeth K Proffitt, Sarah Meng

引用次数: 0

Using Geographic Information Systems (GIS) to Characterize Pediatric Pedestrian Motor Vehicle Accidents in the State of Delaware. 使用地理信息系统(GIS)表征特拉华州儿童行人机动车事故。

Delaware medical journal Pub Date : 2016-07-01

Ravi Talati, Angela Stegmuller, Tim Niiler, Huiyun Xiang, Alfred Atanda

{"title":"Using Geographic Information Systems (GIS) to Characterize Pediatric Pedestrian Motor Vehicle Accidents in the State of Delaware.","authors":"Ravi Talati, Angela Stegmuller, Tim Niiler, Huiyun Xiang, Alfred Atanda","doi":"","DOIUrl":"","url":null,"abstract":"Background: Pediatric pedestrian motor vehicle-associated of injuries correlated with a particular census tract's trauma is a significant public health concern for children. demographic composition. GIS mapping software was used We aimed to use geographic information systems (GIS) to examine the relationship between motor vehicle pedestrian injuries in children and the demographics of the region in which they occurred for the state of Delaware.Methods: This is a retrospective analysis of collected data from the Delaware State Trauma Registry form January 1, 2002, to December 31, 2012. The records of all patients younger than 18 years who went to one of the state's six trauma centers during the study were reviewed. For each injury event, patient demographic information was recorded, and latitude/longitude coordinates of the injury site were determined. Median income, minority population, education level, and percentage of males and children in the census tract were obtained from state census data. Analysis of variance was used to characterize how the frequency of injuries correlated with a particular census tract's demographic composition. GIS mapping software was used to identify specific \"hot spots\" throughout the state where the examine the relationship between motor vehicle pedestrian frequency of traffic crash events was the highest.Results: Urban and poorer areas had tile highest number of injury events, with Wilmington having the highest frequency Methods: This is a retrospective analysis of collected data of injuries per capita. Census tracts with low median income, from the Delaware State Trauma Registry from January 1, lack of high school degree, and increased percentage of 2002, to December 31, 2012. The records of all patients African Americans and females had significantly higher injury younger than 18 years who went to one of the state's six counts compared with other census tracts.Conclusions: In the state of Delaware, children in urban and poor areas are disproportionately affected by motor vehicle-associated pedestrian injuries. Specific risk factors for accidents in these areas need to be identified to facilitate the development of focused prevention strategies.","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"88 7","pages":"206-211"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35362713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Physician Burnout. 医生职业倦怠。

Delaware medical journal Pub Date : 2016-07-01

Dorothy M Moore

引用次数: 0

Be Prepared: Phase 2 HIPAA Audits Set to Begin. 做好准备:第二阶段HIPAA审计即将开始。

Delaware medical journal Pub Date : 2016-06-01

Bruce D Armon, Karilynn Bayus, Brenna D Kelly

引用次数: 0

Example of Coordinated Effort between Behavioral Health and Primary Health Care. 行为健康和初级卫生保健协调努力的例子。

Delaware medical journal Pub Date : 2016-06-01

Mark Lanyon, Beverly Wilson, Terry L Horton