RESUMO
A 40-year-old woman was referred to infectious disease specialists for a Mycobacterium mageritense skin infection following mastectomy and bilateral reconstruction with deep inferior epigastric perforator flap. Her case demonstrates the difficulty in treating non-tuberculosis mycobacterial infections, especially the rarely seen species. She failed to respond to dual antibiotic therapy containing imipenem-cilastin despite reported sensitivity. Additionally, her course was complicated by intolerance to various regimens, including gastrointestinal distress, a drug rash with eosinophilia and systemic symptoms, and tendinopathy. With few published data, no treatment guidelines, and limited medications from which to choose for M. mageritense, her treatment posed a challenge. She ultimately required aggressive surgical intervention and a triple therapy antibiotic regimen. The duration of our patient's treatment and the extent of her complications suggest a potential need for early surgical intervention in postsurgical wounds infected with M. mageritense that do not respond to conventional treatment.
Assuntos
Antibacterianos/uso terapêutico , Ciprofloxacina/uso terapêutico , Desbridamento/efeitos adversos , Doxiciclina/uso terapêutico , Mamoplastia , Mastectomia , Mycobacteriaceae/isolamento & purificação , Complicações Pós-Operatórias/tratamento farmacológico , Adulto , Neoplasias da Mama/cirurgia , Feminino , Humanos , Retalho PerfuranteRESUMO
Two men developed severe tetanus after the 2010 Haitian earthquake. They were admitted to the United States Naval Ship Comfort, a hospital ship sent to provide humanitarian relief. Severe masseter and intercostal muscle spasm impaired airway access and ventilation. Propofol and sevoflurane relieved the tetany, allowing airway control and ventilation without intubation or neuromuscular blocking drugs during wound debridement. Presynaptic impairment of inhibitory neurotransmitter release by tetanospasmin toxin is countered by enhancement of spinal cord postsynaptic inhibitory receptor activity by general anesthetics. Avoidance of tracheal intubation and mechanical ventilation during anesthesia may be desirable in the settings of limited resources in which tetanus usually presents.
Assuntos
Manuseio das Vias Aéreas/métodos , Anestésicos Gerais/uso terapêutico , Desastres , Terremotos , Tétano/terapia , Adulto , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas/efeitos adversos , Desbridamento , Serviços Médicos de Emergência , Evolução Fatal , Haiti , Humanos , Músculos Intercostais/fisiopatologia , Intubação Intratraqueal , Masculino , Bloqueadores Neuromusculares/uso terapêutico , Cuidados Paliativos , Respiração com Pressão Positiva , Navios , Tétano/complicações , Tétano/fisiopatologia , Resultado do Tratamento , Trismo/microbiologia , Trismo/fisiopatologia , Trismo/terapiaRESUMO
The US Navy hospital ship USNS Comfort played an integral role in the initial phases of Operation Unified Response-Haiti following the devastating earthquake that struck near Port-Au-Prince, Haiti, on January 12, 2010. Deployed to Haiti from its home in Baltimore, Maryland, just 4 days after the earthquake, the USNS Comfort would become the region's primary tertiary casualty receiving center for 6 weeks. The pathology and laboratory department staff onboard the ship helped support the mission and experienced unique mass casualty/disaster relief scenarios while underway. This article reviews the accounts of the core laboratory, microbiology, anatomic pathology, and blood bank divisions on the USNS Comfort from the chaotic first few weeks to the final patient discharge 40 days after Operation Unified Response-Haiti began.
Assuntos
Desastres , Terremotos , Medicina Naval/organização & administração , Patologia/organização & administração , Socorro em Desastres , Haiti , Humanos , Laboratórios Hospitalares , Navios , Estados UnidosRESUMO
On 12 January 2010, a 7.0-magnitude earthquake devastated the island nation of Haiti, leading to the world's largest humanitarian effort in over 6 decades. The catastrophe caused massive destruction of homes and buildings and overwhelmed the Haitian health care system. The United States responded immediately with a massive relief effort, sending U.S. military forces and civilian volunteers to Haiti's aid and providing a tertiary care medical center aboard the USNS COMFORT hospital ship. The COMFORT offered sophisticated medical care to a geographically isolated population and helped to transfer resource-intensive patients from other treatment facilities. Working collaboratively with the surgical staff, ancillary services, and nursing staff, internists aboard the COMFORT were integral to supporting the mission of the hospital ship and provided high-level care to the casualties. This article provides the perspective of the U.S. Navy internists who participated in the initial response to the Haitian earthquake disaster onboard the COMFORT.