Necrotizing Fasciitis Occurring After a Conventional Tattoo

A 34-year-old patient presented to the emergency department after getting a tattoo from a licensed tattoo artist at home. The patient was in septic shock with renal failure, and the clinical examination revealed a skin infection at the tattoo site. Suspecting necrotizing fasciitis, the patient underwent fasciotomy with deep tissue sampling and vacuum-assisted closure therapy. Broad-spectrum antibiotic therapy was initiated and later adjusted based on bacterial culture results. The patient quickly recovered and was discharged from the intensive care unit. We report the first case of post-conventional tattoo necrotizing fasciitis in Belgium. The tattoo was performed by a professional licensed tattoo artist, equipped as required by Western legislation. Previously reported cases highlighted necrotizing fasciitis occurring after Samoan or Samoan-style tattoos, an ancestral practice with handmade tools. In our case, the tattoo was done in a conventional way with modern tools and techniques. It is the lack of hygiene precautions that we can attribute to the development of this serious pathology.

Portal-Mesenteric Suppurative Emphysematous Pylephlebitis: A Case Report

Suppurative thrombophlebitis of the portal-mesenteric venous system occurring in the setting of abdominal inflammatory and infectious processes is a serious condition that can lead to septic shock, bowel ischemia, hepatic abscess, and death if unrecognized. Diagnosis is often delayed because symptoms are aspecific and pain at the primary site of infection may be mild. Contrast-enhanced CT scans can diagnose both portal thrombosis and a primary infection site. Treatment may include early resective surgery in case of appendicitis or diverticulitis, in association with large-spectrum antibiotics and possibly anticoagulation. A characteristic of suppurative thrombophlebitis, whether splanchnic or systemic, is the latency before the effects of antibiotic therapy are seen. Anticoagulation can be administered to avoid extension to the superior mesenteric vein. We presented a critically ill 53-year-old man with chronic colonic diverticulitis complicated by suppurative emphysematous portal-mesenteric thrombophlebitis with only a slow response to large-spectrum antibiotics.

[The first our quintet or the channel of care for the most usual urgent pathologies]

The European Community has named five emergencies as being priorities. These five emergencies are: the cardiorespiratory arrest, the myocardial infarction, the severe polytrauma, the cerebral vascular accident and the severe acute dyspnoea. In this article three of them are discussed. Seen with the eyes of a generalist the severe polytrauma requires simple gestures, such as an early call for help by the SMUR, axialisation of head, trunk and members, compression of overtly sources of bleeding and opening the airway to facilitate breathing. The acute myocardial infarction continues to pose problems of diagnosis. The pathognomonic presentations are the STEMI and the N-STEMI infarction. In these cases it is a priority to call for the help of a SMUR unit. In the case of a STEMI infarction it is an absolute priority to admit the patient quickly to hospital and to directly move on to the coronarography ward for a primary angioplasty procedure. Within the first three hours of the infarction, if primary angioplasty is not a possibility within the first 90 minutes, thrombolysis is absolutely indicated. In the case of N-STEMI infarction a quick admission to a coronary care unit is urgent but the treatment is mainly medical. The cerebral vascular incident occurs more frequently than the myocardial infarction, but, culturally, not enough importance is attached to this pathology. Within the first three hours the aim is to get the patient to an emergency department (by means of the SMUR), to evaluate the coagulation values of the patient and to perform a head scan (without the injection of contrast) of good quality. If the patient is not too severely incapacitated (NIH score between 4 and 25), if the head scan does not show a hemorrhagic lesion and if there is no contraindication for thrombolysis, Actilyse should be administered. The time it takes to do all of these acts can not exceed the above mentioned three hours.

Fatal overdose with trazodone: case report and literature review

A fatal case of suicide with trazodone alone in a 40-year-old patient is reported. Life-threatening arrhythmias, such as torsades de pointes and complete AV block, are recorded. Blood collected at admission contained a trazodone toxic concentration of 25.4 micrograms/mL. The patient developed multiple organ failure and died less than 24 hours after his admission to the emergency department. The authors discuss the effects of overdose of trazodone, a well-known safe antidepressant drug.

Changing marital and family patterns: a test of the post-modern perspective

"Four central constructs of the post-modern perspective are extended and tested using secondary analysis of [U.S.] Census data and the NORC General Social Survey: 1972-94 data sets. The modified postmodern themes of: (1) the decline of a single universal family organizational standard, and (2) growing cultural diversity...were supported by examining changes in American family structure, attitudes toward such structural changes, and changing attitudes toward marital and family patterns over the last quarter century. However, little support was found for the greater use of, and reliance on, (3) the mass media. Mixed results were found on the fourth construct, greater variance in, and/or loss of, personal happiness or personal or family life satisfaction."

Prostate cancer metastatic to the stomach. Clinical aspects and endoscopic diagnosis

Although prostate carcinoma is the most common malignancy in males, it rarely involves the gastrointestinal (GI) tract. We report the first case of endoscopically diagnosed prostate carcinoma metastatic to the stomach in an 88-year-old man whose heralding symptoms were nausea, vomiting, and epigastric pain. The initial diagnosis was not suggested at presentation, but an upper endoscopy and biopsy suggested adenocarcinoma of uncertain primary site subsequently confirmed to be of prostatic origin by immunohistochemical staining. We review the clinical aspects and endoscopic diagnosis of this condition.

Influence of ageing on IgE-mediated reactions in allergic patients

The influence of age and sex has been evaluated in 326 allergic patients on the following parameters: total serum IgE concentration, serum concentration of specific IgE antibodies against seventeen common allergens, mean number of positive allergens, absolute numbers of circulating eosinophils, corticosteroid dependence and response to sodium cromoglycate (DSCG). The results indicate that age and sex significantly influence the IgE antibody production in these patients. The data strongly suggests the appearance during ageing of a progressive natural desensitization. This contrasts with the increased frequency of corticosteroid-dependent cases during ageing. There is an inverse relation between age and response to DSCG therapy.