Improvement in the high mortality from Staphylococcus aureus septicemia must address the individualized treatment (surgery and/or prolonged antibiotic treatment) of metastatic complications. The aim of this study was to evaluate the results of a comprehensive diagnostic monitoring for metastatic complications in S. aureus septicemia. 68 consecutive patients with S. aureus septicemia were prospectively followed. The performance rate and results of chest X-ray, echocardiography, bone scintigraphy and leukocyte scintigraphy are described. Metastatic complications were found in 53% of the 68 patients, endocarditis in 26%. Positive findings resulted in surgical intervention in 23 patients. The total mortality defined as all deaths within 12 weeks was 24%; 81% of the deceased were > or = 60 years of age. Non-endocarditis patients with peripheral septic metastases had good prognosis. An active monitoring for metastatic complications in S. aureus septicemia is a necessary prerequisite for optimizing treatment and to improve survival rate.
In a prospective, non‐randomized study 40 athletes with contusion or distension injuries to the thigh or the calf muscle were followed with tests of range of motion (ROM) of knee or ankle joint, test of serum creatine kinase (CK) and ultrasonography of the injury until completely recovered. An experimental group of 19 injuries where subjects received treatment with application of a maximum compression bandage within 5 min (mean=2 min) of the injury was compared to a control group of 21 injuries where subjects were treated with rest and elevation only, and in some cases non‐maximum compression after 10–30 min. No significant differences were noted with respect to time to complete subjective recovery, ultrasonic size of the injury or time to normal findings on ultrasound between treatment and control groups. Strain injuries, although showing a tendency to be smaller in size, took a longer time to complete recovery than contusion injuries (mean±SD=26±22 days and 19±9 days, respectively, P=0.02). Diagnostic CK values and reductions in ROM were not correlated to the severity of the trauma, while ROM showed weak correlation to the sonographically measured size of the hematoma (r=0.42; P<0.01). Injuries displaying a circumscript anechoic, low‐echogenic or mixed lesion at the diagnostic ultrasound investigation normalized more slowly (P=0.001) and took longer to complete recovery (P=0.001) than injuries with diffuse hyperechogenic lesions. We conclude that in this study the application of a maximum compression bandage within 5 min of a muscle trauma did not significantly reduce the size of the hematoma nor significantly shorten the time to complete subjective recovery compared with no immediate treatment. The diagnostic ultrasound investigation was valuable in predicting the severity of the trauma.
The hypothesis that asymptomatic visual field defects can be found in patients with carotid transient ischaemic attacks (TIA) or minor strokes was tested. Twenty-two consecutive male patients with TIA and 18 patients with minor strokes from the carotid artery territory were examined by perimetry, cerebral computerised tomography and regional cerebral blood flow. Asymptomatic visual field defects were found in many TIA and minor stroke patients, 29% (5/17) and 57% (8/14), respectively (NS). Eighty-five per cent (11/13) of the scotomas were solely or predominantly located in the upper part of the visual field (P = 0.008 for absolute defects and P = 0.03 for relative defects). We conclude that both carotid territory TIA and minor stroke patients have a high frequency of asymptomatic visual field defects, predominantly located in the upper part of the visual field.
A standardized trauma was inflicted to the lateral side of the calf muscle of 12 New Zealand rabbits, creating a muscle hematoma without external bleeding. The acute hematoma was evaluated within 3 h with radionuclide imaging of red blood cells labelled with 99mTc pertechnetate, ultrasonography and magnetic resonance imaging (MRI). The results were compared with the total volume of the hematomas as calculated from histological preparations of each injured muscle. Scintigraphy and T2‐weighted MRI accurately detected all hematomas but the calculated volume did not significantly correlate with histology. T1‐weighted MRI did not detect the hematomas. Ultrasonography detected all hematomas and also accurately evaluated the volume. In conclusion, scintigraphy, MR imaging and ultrasonography are all sensitive enough to detect an acute muscle injury, but in this investigation only ultrasonography accurately quantified the volume of the hematoma.
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