• Title/Summary/Keyword: Acute osteomyelitis

검색결과 40건 처리시간 0.023초

감염성 척추염과 감별질환의 병태생리와 MRI 소견 (Pathophysiology and MRI Findings of Infectious Spondylitis and the Differential Diagnosis)

  • 유선진;김여주;이승훈;류정아;박성훈;홍정의
    • 대한영상의학회지
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    • 제82권6호
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    • pp.1413-1440
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    • 2021
  • MRI에서 추간판의 이상 신호와 위, 아래 척추체 종판의 파괴, 종판 주변의 골수부종 등은 감염성 척추염의 전형적인 소견으로 여겨지나 퇴행성 척추질환, acute Schmorl's node, 척추관절병증, synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO)/chronic recurrent multifocal osteomyelitis, 척추신경관절병증, calcium pyrophosphate dehydrate 결절침착질환 등 다양한 비감염성 척추질환에서도 나타날 수 있다. MRI에서 이러한 비감염성 척추질환과 감별되는 감염성 척추염의 영상 소견은 추간판의 고신호와 농양, 척추 연부조직의의 농양, 그리고 T1 강조영상에서 저신호로 보이는 종판의 경계가 불명확해지는 점 등이다. 그러나 이러한 감별점이 항상 적용되는 것은 아니며 감염성, 비감염성 질환의 영상 소견에 유사점이 많기 때문에 정확한 진단을 위해서는 감염성 척추염뿐만 아니라 감염과 감별해야 하는 다양한 질환의 병태생리와 연관된 영상학적 특징을 아는 것이 중요하다.

재발된 좌심방점액종의 치험 1예 (Recurrent Left Atrial Myxoma: A Case Report)

  • 장명;이철주;김광호;홍승록
    • Journal of Chest Surgery
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    • 제14권3호
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    • pp.260-267
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    • 1981
  • Left atrial myxoma is a rare disease and its recurrence is reported to be always possible whenever primary excision is incomplete. Cardiac Myxoma is rare disease of the heart, and it has a little chance of recurrence. We experienced a patient of recurrent left atrial myxoma who was 31 years old, had been gotten excision of Lt. atrial myxoma when she was 28 years of her age. She was gotten mitral valve replacement simultaneously during 2nd operation with difficulty. So we report this case with the review of the literatures. [KTCS 1981;3:260-267]Surgical Treatment of Acute Pyogenic Pericarditis followed the Sepsis Ki Woo Shin, M.D.,* Ho Wan Lee, M.D.* and Dong Jun Lee, M.D.* Two cases of acute pyogenic pericarditis are, one case, 12-year-old male patient, followed the bacteremia of pneumonia and other case, 9 year old female patient, followed the bacteremia of osteomyelitis. After the confirmed diagnosis by pericardial aspiration, the emergency pericardial window was made to relief the severe cardiogenic symptoms. The general symptoms were improved immediately, but 40 days and 15 days after pericardiostomy, in each case, the sign and symptoms of cardiac compression were seen with recurrent cardiac tamponade. Pericardiectomy with median sternotomy was performed in each case and thereafter the patients were discharged without any problems.

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A case of meningoencephalitis caused by $Listeria$ $monocytogenes$ in a healthy child

  • Lee, Ji-Eun;Cho, Won-Kyoung;Nam, Chan-Hee;Jung, Min-Ho;Kang, Jin-Han;Suh, Byung-Kyu
    • Clinical and Experimental Pediatrics
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    • 제53권5호
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    • pp.653-656
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    • 2010
  • $Listeria$ $monocytogenes$ is a facultative anaerobic, gram-positive bacillus that is isolated from the soil, vegetables, and wild or domestic animals. Listeria occurs predominantly in the elderly, immunocompromised patients, pregnant women and newborns. Infections by this microorganism are rare in healthy infants and children. $L.$ $monocytogenes$ may cause meningitis, meningoencephalitis, brain abscess, pyogenic arthritis, osteomyelitis, and liver abscesses in children. The course of meningoencephalitis by listeria is often severe and even fatal. Acute hydrocephalus can develop as a complication and the mortality associated with listeriosis is significantly high. We present a case of meningoencephalitis caused by $L.$ $monocytogenes$ in a previously healthy 7-year-old girl.

유경 족배 도서형 피판을 이용한 족부 및 하지 원위부 재건술 (Reconstruction of the Heel and Distal Leg Using Pedicled Dorsalis Pedis Island Flap)

  • 이준모;유창은
    • Archives of Reconstructive Microsurgery
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    • 제12권2호
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    • pp.112-118
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    • 2003
  • Purpose : Soft tissue defect and exposed tendons and bones with concomitant infection in the foot and lower leg have to be covered with vascularized flap as the one stage treatment. Authors have performed 6 cases of pedicled dorsalis pedis island flaps under the loupes magnification and evaluated the benefits. Materials and methods : From 1994 through 2003, we have performed 6 pedicled dorsalis pedis island flaps for reconstruction of soft tissue defects in the foot and lower leg. The causes were trauma in 3 cases, skin necrosis and secondary infection after Achilles tendon repair in 2 cases and acute osteomyelitis in 1 case. Average age was 38 years and 5 cases were male and 1 female. The results of the procedure was evaluated by survival of the island flap, comfort in putting on shoes and walking, comfort in the donor site, comfort in the recipient site and range of motion of the ankle joint. Results : All pedicled dorsalis pedis island flaps survived except 1. Three cases felt discomfort in the dorsum of foot as the donor site and 1 case of the Achilles tendon ruptured and repaired showed limited dorsiflexion of ankle joint. Conclusion : Nonmicrosurgical pedicled dorsalis pedis island flaps under the loupes magnification are one of the useful treatment methods because procedure is rapid, survival is confident and overall reconstructive results are good.

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통풍성 궤양의 수술적 절제 후 음압배액법을 통한 치료 (Use of post-operative negative-pressure wound therapy for gouty ulcer)

  • 오창열;최정란;손민수;조선영;허준호;박정규;오동호;이영현
    • Journal of Yeungnam Medical Science
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    • 제32권1호
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    • pp.42-46
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    • 2015
  • Gouty ulcer can be caused by the accumulation of clumps of uric acid in body tissues that lead to acute or chronic inflammation at sites of accumulation. Furthermore, tophi-inhibiting granulation tissue may form a canal that channels microbial infection from the underlying involved joint space, and thus, presents the risk of osteomyelitis development. Accordingly, gouty ulcer must be treated appropriately. In this case, refractory wounds on gouty ulcers at the left shin and left radial ankle were treated by surgical debridement. Negative-pressure wound therapy was used successfully to prevent post-operative delayed wound healing.

Cutaneous mucormycosis of the lower extremity leading amputation in two diabetic patients

  • Coerdt, Kathleen M.;Zolper, Elizabeth G.;Starr, Amy G.;Fan, Kenneth L.;Attinger, Christopher E.;Evans, Karen K.
    • Archives of Plastic Surgery
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    • 제48권2호
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    • pp.231-236
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    • 2021
  • Mucormycosis is an invasive, rapidly progressive, life-threatening fungal infection, with a propensity for diabetic, immunosuppressed, and trauma patients. The classic rhinocerebral variation is most common in diabetic patients. While the cutaneous form is usually caused by direct inoculation in immunocompetent patients. Cutaneous mucormycosis manifests in soft tissue and risks involvement of underlying structures. Tibial osteomyelitis can also occur secondary to cutaneous mucormycosis but is rare. Limb salvage is typically successful after lower extremity cutaneous mucormycosis even when the bone is involved. Herein, we report two cases of lower extremity cutaneous mucormycosis in diabetic patients that presented as acute worsening of chronic pretibial ulcers. Despite aggressive antifungal therapy and surgical debridement, both ultimately required amputation. Such aggressive presentation has not been reported in the absence of major penetrating trauma, recent surgery, or burns.

급성 화농성 슬관절염에서 관절경적 치료 후 결과 (Clinical Results after Arthroscopic Treatment in Acute Pyogenic Arthritis of the Knee)

  • 이정환;윤경호;배대경;김정원;박수연
    • 대한관절경학회지
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    • 제12권1호
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    • pp.53-57
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    • 2008
  • 목적: 슬관절에 발생한 급성 화농성 관절염의 관절경적 치료 후 결과에 대하여 분석하였다. 대상 및 방법: 2000년 7월에서 2005년 1월까지 16예(15명)의 관절경적 치료를 시행한 급성 화농성 슬관절염 환자를 대상으로 하였다. 환자의 평균 나이는 61.9세였고 평균 추시 기간은 30.5개월이었다. 당뇨병이나 퇴행성 관절염 등의 기존 질환이 있었던 경우가 8예 였으며 과거력상 슬관절에 침을 맞거나 관절내 주사를 시행 받은 경우가 14예였다. 결과: 원인균의 동정이 가능했던 예는 7예(43.8%)였다. 술 후 정맥 내 항생제를 평균 25.5일 사용하였으며 경구 항생제를 평균 22.5일 사용하였다. 슬관절 강직 5예, 이차성 관절염 2예, 슬관절 주위 만성 골수염 1예, 사망 3예 등 총 11예의 합병증이 발생하였다. 수술 후 3주 이상 부목 고정을 시행한 경우 슬관절 강직이 유의하게 많았으나(p=0.032) 증상 발현 후 1 주일을 기준으로 치료까지의 기간에 따른 합병증의 발생 빈도는 차이를 보이지 않았다(p=0.293). 배양 검사 상 원인균이 동정된 경우 더 많은 합병증이 발생하였다(p=0.034). 결론: 화농성 슬관절염의 관절경적 치료 후 관절 강직의 발생 빈도와 고정 기간과 상관 관계가 있었다. 합병증 발생 빈도는 증상 후 치료까지의 기간과는 연관이 없었으나 원인균의 동정된 여부와는 연관이 있었다.

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소아기 골 감염의 진단방법에 관한 조사 (Diagnostic Methods Used in the Bone Infections in Children)

  • 이은실;최광해
    • Pediatric Infection and Vaccine
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    • 제4권2호
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    • pp.210-217
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    • 1997
  • 목 적 : 골 감염의 조기 진단 및 적절한 치료는 감염의 만성화와 영구적 신체 장애를 예방하는데 중요하며, 조기 진단에는 동위 원소 검사가 가장 도움이 된다고 알려져 있다. 이에 저자는 세균학적으로 확진된 소아기 골 감염 환자들의 진단에 이용되었던 방법들을 검토하여 골 감염의 조기 진단에 가장 유용하였다고 생각되는 방법을 찾아 보고자 하였다. 방 법 : 1991년 1월부터 1997년 6월까지 6년 5개월간 영남대학교 의과대학 부속병원에 골 감염을 의심하여 입원했던 소아 환아 중 압통 부위 천자 후 검체를 배양하여 세균학적으로 증명된 급성 화농성 골수염 및 급성 화농성 관절염을 가졌던 29명을 대상으로 병록지 검토와 방사선학적 검사 및 동위원소 검사의 결과를 분석하는 후향적 연구를 시행하였다. 결과: 1) 대상 환아 29명의 연령 분포는 생후 4주 이내의 신생아가 5례(17.2%), 4주에서 l년 이내의 영아가 l례(3.4%), 1 세에서 15세 미만이 23례(79.3%)였고 남녀비는 1.4:1 이었다. 2) 진단시 진찰 소견으로는 국소 압통이 29례(100.0%) 전례에서 관찰되어 가장 흔한 소견이었고 그 외 환부종창, 관절 운동 제한, 열, 국소 열강 등의 순으로 많았으며 병적 골절도 1례에서 있었다. 3) 증상 발현 후 1주 이내 내원한 경우가 15례(51.7%)였고 29례(100.0%) 모두는 15일 이내에 내원하였다. 4) 검사소견으로 입원 당시 말초혈액 총 백혈구 수는 증가된 경우는 17례(58.6%)에 불과하였으나, 적혈구 침강 속도가 증가된 경우는 28례(96.6%)였고 CRP는 27례(93.1 %)에서 증가되었다. 5) 천자한 검체에사 배양된 균주는 Staphylococcus aureus가 전체 29례중에서 25례(86.0%)로 가장 많았다. 6) 단순 방사선 소견이 정상이거나 연부조직 종창만 보인 경우가 15례(51.7%), 골의 변화를 동반한 경우가 14례(48.3%)였다. 단순 방사선 소견이 정상이었던 환아 중에서 동위원소 검사를 시행했던 경우가 6례 있었으며, 이 중 동위 원소의 흡수 증가가 관찰된 경우가 5례였다 단순 방사선 검사상 비특이적 소견만 보인 1 례에서 시행한 골 자기 공명 촬영에서 골막하 농양이 관찰되었다. 결 론 : 골 감염의 조기 진단시 단순 방사선 검사에서 특이 소견을 관찰할 수 있는 경우는 48.3%에 지나지 않았고 동위 원소 검사 역시 6례 중 1례에서는 음성 소견을 보였다. 따라서 소아에서 임상적으로 골 감염이 의심되는 경우에는 압통 부위의 천자를 시행하여 세균학적 검사를 시행한 후 즉시 치료를 시작하는 것이 골 감염의 진단과 치료에 유용하다고 생각되며, 방사성 동위 원소 검사와 자기 공명 촬영이 조기 진단에 도움이 되는 검사이기는 하나 진단이 모호할 경우 치료를 시작한 후 시행해도 무방할 것으로 생각된다.

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면역기능이 정상인 영아에서 동경주 BCG 백신 접종 후 발생한 파종성 Mycobacterium bovis 감염 1예 (A Case of Disseminated Mycobacterium bovis Infection after BCG Vaccination (Tokyo strain) in an Apparently Immunocompetent Infant)

  • 백지연;최재홍;김민경;최은화;이환종;박경운
    • Pediatric Infection and Vaccine
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    • 제18권1호
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    • pp.91-96
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    • 2011
  • BCG는 M. bovis로부터 유래된 생백신으로 5-6세 미만의 소아 결핵 특히 결핵성 수막염이나 속립성 결핵과 같은 중증 결핵의 예방 효과가 인정되고 있다. BCG 접종 후 이상반응은 국소 궤양 형성, 국소 림프절염이 가장 흔하며, 드물지만 골수염, 파종성 감염과 같은 치명적인 합병증도 있다. 파종성 BCG 감염은 주로 면역저하 환자에게서 흔하게 관찰되며 면역 저하가 없는 소아에게서 발생한 파종성 BCG 감염은 국내 문헌상 보고가 없었다. 저자들은 13개월 여환이 BCG 접종 5개월 뒤 발생한 발열, 피부 결절 및 다발성 림프절 종대를 주소로 내원하여, 백 신 접종 부위 외에 2군데에서 M. bovis BCG를 확인한 후 파종성 BCG 감염으로 진단된 1례를 경험하였다. 환아는 isoniazid와 rifampin으로 치료받았으며 약 2주 간의 입원 치료 후 임상 증상이 호전되어 퇴원하였다. 3주뒤 외래 추적 관찰에서 역설적 반응으로 생각되는 림프 절 종대와 피부 결절이 진행하였으나 동일 약제를 유지하면서도 다시 임상 증상이 호전되었고 환아의 면역학적 검사상 이상 소견이 관찰되지 않았기에 이를 보고하는 바이다.

가정간호 기록지 분석 - 원주기독병원 가정간호 보건활동을 중심으로 - (An Analysis of Referrals, Nursing Diagnosis, and Nursing Interventions in Home Care - Wonju Christian Hospital Community Health Nursing Service -)

  • 서미혜;허혜경
    • 가정∙방문간호학회지
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    • 제3권
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    • pp.53-66
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    • 1996
  • Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

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