RESUMEN
CASE: Two patients presented with infections of their recent proximal humerus fracture sites. These immunocompromised patients were being treated nonoperatively for their proximal humerus fractures; however, both were taken to the operating room for surgical debridement. CONCLUSIONS: These 2 cases demonstrate the need for further investigation into infection of closed fracture sites. Attention should be paid to immunocompromised patients who present with proximal humerus fractures, especially displaced 2-part surgical neck fractures with anterior deltoid injury and subsequent hematoma formation. These patients may develop an infection with potential rapid progression to life-threatening septic shock.
Asunto(s)
Hematoma/complicaciones , Choque Séptico/microbiología , Fracturas del Hombro/complicaciones , Infecciones Estafilocócicas/complicaciones , Antibacterianos/uso terapéutico , Femenino , Humanos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Persona de Mediana Edad , Choque Séptico/tratamiento farmacológico , Fracturas del Hombro/diagnóstico por imagen , Infecciones Estafilocócicas/tratamiento farmacológicoRESUMEN
Seizures have both local and remote effects on nervous system function. Whereas propagated seizures are known to disrupt cerebral activity, little work has been done on remote network effects of seizures that do not propagate. Human focal temporal lobe seizures demonstrate remote changes including slow waves on electroencephalography (EEG) and decreased cerebral blood flow (CBF) in the neocortex. Ictal neocortical slow waves have been interpreted as seizure propagation; however, we hypothesize that they reflect a depressed cortical state resembling sleep or coma. To investigate this hypothesis, we performed multimodal studies of partial and secondarily generalized limbic seizures in rats. Video/EEG monitoring of spontaneous seizures revealed slow waves in the frontal cortex during behaviorally mild partial seizures, contrasted with fast polyspike activity during convulsive generalized seizures. Seizures induced by hippocampal stimulation produced a similar pattern, and were used to perform functional magnetic resonance imaging weighted for blood oxygenation and blood volume, demonstrating increased signals in hippocampus, thalamus and septum, but decreases in orbitofrontal, cingulate, and retrosplenial cortex during partial seizures, and increases in all of these regions during propagated seizures. Combining these results with neuronal recordings and CBF measurements, we related neocortical slow waves to reduced neuronal activity and cerebral metabolism during partial seizures, but found increased neuronal activity and metabolism during propagated seizures. These findings suggest that ictal neocortical slow waves represent an altered cortical state of depressed function, not propagated seizure activity. This remote effect of partial seizures may cause impaired cerebral functions, including loss of consciousness.