The Experts below are selected from a list of 12 Experts worldwide ranked by ideXlab platform
T Drosch - One of the best experts on this subject based on the ideXlab platform.
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Endocarditis caused by Propionibacterium acnes -- a diagnostic and therapeutic challenge
Deutsche medizinische Wochenschrift (1946), 2013Co-Authors: T Drosch, M Egle, L ZabelAbstract:A 77-year-old man suffered from recurrent peripheral cerebral embolisms five months after aortic valve replacement with a bioprosthesis (SJM Epic 25 mm). MRT scanning of the brain revealed multiple ischemic areas in different vascular territories. Clinical signs of infective endocarditis were missing and markers of infection were only modestly increased. However, transthoracic echocardiography showed elevated pressure gradients across the bioprosthesis. Transesophageal echocardiography detected multiple vegetations suggestive of infective endocarditis. Several anaerobic blood cultures grew Propionibacterium acnes. Infective endocarditis affecting the aortic bioprosthesis and aortic root abscess due to Propionibacterium acnes was diagnosed. During parenteral antibiotic treatment with Amicillin/Sulbactam and Gentamicin full remission developed. Four months later a follow-up transesophageal echocardiography showed a relapse. This time the patient was treated intravenously with penicillin and gentamicin and underwent surgical treatment. Cardioembolic events should raise suspicion of infective endocarditis, even if typical clinical signs are absent. Propionibacterium acnes is often grown from blood cultures as a contaminant. Nonetheless, Propionibacterium acnes was the cause of the infective endocarditis. In case of conservative management, close intervals of follow-up transesphageal echocardiography are of importance. © Georg Thieme Verlag KG Stuttgart · New York.
M Egle - One of the best experts on this subject based on the ideXlab platform.
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Endocarditis caused by Propionibacterium acnes -- a diagnostic and therapeutic challenge
Deutsche medizinische Wochenschrift (1946), 2013Co-Authors: T Drosch, M Egle, L ZabelAbstract:A 77-year-old man suffered from recurrent peripheral cerebral embolisms five months after aortic valve replacement with a bioprosthesis (SJM Epic 25 mm). MRT scanning of the brain revealed multiple ischemic areas in different vascular territories. Clinical signs of infective endocarditis were missing and markers of infection were only modestly increased. However, transthoracic echocardiography showed elevated pressure gradients across the bioprosthesis. Transesophageal echocardiography detected multiple vegetations suggestive of infective endocarditis. Several anaerobic blood cultures grew Propionibacterium acnes. Infective endocarditis affecting the aortic bioprosthesis and aortic root abscess due to Propionibacterium acnes was diagnosed. During parenteral antibiotic treatment with Amicillin/Sulbactam and Gentamicin full remission developed. Four months later a follow-up transesophageal echocardiography showed a relapse. This time the patient was treated intravenously with penicillin and gentamicin and underwent surgical treatment. Cardioembolic events should raise suspicion of infective endocarditis, even if typical clinical signs are absent. Propionibacterium acnes is often grown from blood cultures as a contaminant. Nonetheless, Propionibacterium acnes was the cause of the infective endocarditis. In case of conservative management, close intervals of follow-up transesphageal echocardiography are of importance. © Georg Thieme Verlag KG Stuttgart · New York.
L Zabel - One of the best experts on this subject based on the ideXlab platform.
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Endocarditis caused by Propionibacterium acnes -- a diagnostic and therapeutic challenge
Deutsche medizinische Wochenschrift (1946), 2013Co-Authors: T Drosch, M Egle, L ZabelAbstract:A 77-year-old man suffered from recurrent peripheral cerebral embolisms five months after aortic valve replacement with a bioprosthesis (SJM Epic 25 mm). MRT scanning of the brain revealed multiple ischemic areas in different vascular territories. Clinical signs of infective endocarditis were missing and markers of infection were only modestly increased. However, transthoracic echocardiography showed elevated pressure gradients across the bioprosthesis. Transesophageal echocardiography detected multiple vegetations suggestive of infective endocarditis. Several anaerobic blood cultures grew Propionibacterium acnes. Infective endocarditis affecting the aortic bioprosthesis and aortic root abscess due to Propionibacterium acnes was diagnosed. During parenteral antibiotic treatment with Amicillin/Sulbactam and Gentamicin full remission developed. Four months later a follow-up transesophageal echocardiography showed a relapse. This time the patient was treated intravenously with penicillin and gentamicin and underwent surgical treatment. Cardioembolic events should raise suspicion of infective endocarditis, even if typical clinical signs are absent. Propionibacterium acnes is often grown from blood cultures as a contaminant. Nonetheless, Propionibacterium acnes was the cause of the infective endocarditis. In case of conservative management, close intervals of follow-up transesphageal echocardiography are of importance. © Georg Thieme Verlag KG Stuttgart · New York.
Chien-chang Lee - One of the best experts on this subject based on the ideXlab platform.
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An erythematous and draining umbilicus
The Journal of emergency medicine, 2006Co-Authors: Chien-chang Lee, Chih Hao Lin, Zui-shen YenAbstract:20-year-old man presented to the Emergency Departent (ED) with fever, abdominal pain, and yellowish ilky discharge of the umbilicus for 3 days. He noted the mbilicus draining straw-colored fluid about 1 week rior, and developed periumbilical erythema and tenderess. He had two other episodes of umbilical drainage ith fluid during the prior 3 months. He was quite ealthy before and denied history of recent abdominal njuries. The vital signs were: temperature of 38.2°C, a lood pressure of 143/83 mm Hg, a respiratory rate of 12 reaths/min, and a pulse rate of 100 beats/min. Physical xamination revealed an erythematous, swollen, and ildly everted umbilicus (Figure 1). The most tender rea was located about 2 cm below the umbilicus in the idline. Purulent discharge could be expressed manually ith infra-umbilical pressure towards the umbilicus. No uscle guarding or rebound tenderness of the abdomen as noted. Laboratory tests revealed increased leukocyte ount of 10.9 1000/mm with 83% neutrophils. Serum iochemistry tests and urinary dipstick test were normal. Sagittal midline ultrasound scan of the abdomen by an mergency physician revealed a hypoechoic complex eneath the umbilicus (Figure 2). The findings were ighly suggestive of an infected umbilical urachal sinus. road-spectrum antibiotic therapy with intravenous amicillin/sulbactam was administered. The symptoms of
Chih Hao Lin - One of the best experts on this subject based on the ideXlab platform.
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An erythematous and draining umbilicus
The Journal of emergency medicine, 2006Co-Authors: Chien-chang Lee, Chih Hao Lin, Zui-shen YenAbstract:20-year-old man presented to the Emergency Departent (ED) with fever, abdominal pain, and yellowish ilky discharge of the umbilicus for 3 days. He noted the mbilicus draining straw-colored fluid about 1 week rior, and developed periumbilical erythema and tenderess. He had two other episodes of umbilical drainage ith fluid during the prior 3 months. He was quite ealthy before and denied history of recent abdominal njuries. The vital signs were: temperature of 38.2°C, a lood pressure of 143/83 mm Hg, a respiratory rate of 12 reaths/min, and a pulse rate of 100 beats/min. Physical xamination revealed an erythematous, swollen, and ildly everted umbilicus (Figure 1). The most tender rea was located about 2 cm below the umbilicus in the idline. Purulent discharge could be expressed manually ith infra-umbilical pressure towards the umbilicus. No uscle guarding or rebound tenderness of the abdomen as noted. Laboratory tests revealed increased leukocyte ount of 10.9 1000/mm with 83% neutrophils. Serum iochemistry tests and urinary dipstick test were normal. Sagittal midline ultrasound scan of the abdomen by an mergency physician revealed a hypoechoic complex eneath the umbilicus (Figure 2). The findings were ighly suggestive of an infected umbilical urachal sinus. road-spectrum antibiotic therapy with intravenous amicillin/sulbactam was administered. The symptoms of