In the Department of Oral and Maxillofacial Surgery, patients with trismus can be easily identified. If the cause of trismus is infection of the masticatory space near the pterygoid plexus, the possibility of cavernous sinus thrombosis should be considered. We report the case of a patient who presented with limited mouth opening and progressed to cavernous sinus thrombosis, along with a review of the relevant literature.
Cavernous Sinus Thrombosis* ; Focal Infection, Dental ; Humans ; Mouth ; Surgery, Oral ; Trismus*

Cavernous sinus thrombosis not only presents with constitutional symptoms including fever, pain and swelling but also with specific findings such as proptosis, chemosis, periorbital swelling, and cranial nerve palsies. It is known to occur secondary to the spread of paranasal sinus infections in the nose, ethmoidal and sphenoidal sinuses. However, paranasal sinus infection of dental origin is rare. The following is a case of cavernous sinus thrombosis due to the spread of an abscess in the buccal and pterygomandibular spaces via buccal mucosal laceration.
Abscess ; Cavernous Sinus ; Cavernous Sinus Thrombosis* ; Cranial Nerve Diseases ; Exophthalmos ; Fever ; Focal Infection, Dental ; Lacerations ; Nose ; Sepsis

PURPOSE: This study investigated the predictive factors for identifying infection-prone febrile infants younger than three months. METHODS: We conducted a retrospective study of 167 infants younger than three months with an axillary temperature >38degrees C who were hospitalized between 2006 and 2008. If they met any of the following criteria, positive blood culture, CSF WBC > or =11/mm3 or positive CSF culture, urinalysis WBC > or =6/HPF and positive urine culture, WBC > or =6/HPF on microscopic stool examination or positive stool culture, they were considered at high risk for severe infection. Infants with focal infection, respiratory infection or antibiotic administration prior to admission to the hospital were excluded. We evaluated the symptoms, physical examination findings, laboratory data, and the clinical course between the high risk and low risk groups for severe infection. RESULTS: The high-risk group included 77(46.1%) infants, and the most common diagnosis was urinary tract infection (51.9%). Factors, such as male sex, ESR and CRP were statistically different between the two groups. But, a multilinear regression analysis for severe infection showed that male and ESR factors are significant. CONCLUSION: We did not find the distinguishing symptoms and laboratory findings for identifying severe infection-prone febrile infants younger than three months. However, the high-risk group was male and ESR-dominated, and these can possibly be used as predictive factors for severe infection.
Focal Infection ; Humans ; Infant ; Male ; Physical Examination ; Retrospective Studies ; Urinalysis ; Urinary Tract Infections

PURPOSE: The purpose of this study is to evaluate the incidence and cause of reamputation with respect to the location of foot amputation. MATERIALS AND METHODS: Eighty-six patients who received amputations below the ankle level from March 2002 to September 2012 with at least 1 year follow-up were enrolled in this study. We stratified the site of the initial amputation from first to fifth ray and into either the phalanx or metatarsal bone, and investigated the cause of reamputation. RESULTS: The reamputation rate below the ankle level was 53.5%. It was highest (62.1%) in patients with first ray amputations without statistical significance. Rays were divided into two columns, first to third rays as the medial column and others as the lateral column, and reamputation was performed in 61.2% of patients with medial column amputation. Comparing the results between phalanx and metatarsal amputations, reamputation was performed in 62.1% of patients with metatarsal bone amputation. The rate of reamputation was statistically significant in both the medial column and metatarsal amputations. The most common reamputation site, in accordance to the initial site of amputation, was the adjacent ray (57.4%), which was without statistical significance. Moreover, the most common cause of reamputation was osteomyelitis and focal infection in all rays. CONCLUSION: This study showed that reamputation after amputation below the ankle level was relatively common with highest rate in medial column and metatarsal amputations. Hence, surgeons should be aware of the risk of reamputation and put more preventive effort during medial column and metatarsal amputations.
Amputation* ; Ankle ; Focal Infection ; Follow-Up Studies ; Foot* ; Humans ; Incidence ; Metatarsal Bones ; Osteomyelitis

OBJECTIVETo report nine cases of descending necrotizing mediastinitis (DNM) and to summarize the management experience.

METHODSBetween December 2005 and December 2008, nine patients (mean age, 55.7 years; age range, 38 to 78 years) with DNM were treated. Eight patients underwent surgical drainage of the involved cervical region and mediastinum (4 with cervical drainage alone; 4 with cervical drainage and right thoracotomy).

RESULTSTwo patients died, one of them refused surgical therapy and the other one died of multiorgan failure related to postoperative septic shock. Seven patients recovered. The mortality rate was 22%.

CONCLUSIONSDelayed diagnosis and inadequate drainage are the main causes of high mortality rate of DNM. Aggressive surgical drainage and debridement of the neck and mediastinum by a multidisciplinary team of surgeons are very important in the treatment of DNM.

Non-typhoidal Salmonella species are important foodborne pathogens that can cause gastroenteritis, bacteremia, and subsequent focal infections. Non-typhoidal salmonellosis is problematic, particularly in immunocompromised hosts. Any anatomical site can be affected by this pathogen via hematogenous seeding and may develop local infections. However, cervical lymphadenitis caused by non-typhoidal Salmonella species is rarely reported. Herein, we have reported a case of cervical lymphadenitis caused by group D non-typhoidal Salmonella associated with lymphoma.
Bacteremia ; Focal Infection ; Gastroenteritis ; Immunocompromised Host ; Lymphadenitis ; Lymphoma ; Salmonella ; Salmonella Infections ; Seeds

Clinical manifestations of Salmonella infection are variable such as enterocolitis, bacteremia, enteric fever, focal infection and asymptomatic carrier status. Among these presentations, enterocolitis is the most common clinical manifestation and can be diagnosed by the use of fecal specimens. Patients with severe infectious colitis are at increased risk of developing a colon perforation after colonoscopy due to colon trauma. We report a case of a 31-year-old woman with transverse colon perforation after colonoscopy that was diagnosed with enterocolitis caused by infection with non-typhoidal group D Salmonella.
Adult ; Bacteremia ; Colitis ; Colon ; Colon, Transverse ; Colonoscopy ; Enterocolitis ; Female ; Focal Infection ; Humans ; Megacolon, Toxic ; Salmonella ; Salmonella Infections ; Typhoid Fever

Pustular eruptions of the palms and soles was studied on outpatients at the Departm- ent of Dermatology of Kyungpook National University Hospital. The results were as follows. 1. During 4 years from 1971 to 1974, the total number of outpatients were 9, 107, among which pustular eruptions were 124 cases(1.34%) and tinea pedis et manus were 171 cases(1.88%). 2. Among 86 cases of pustular eruptione seen in 1974, the classic cases of acrodermatitis continua of Hallopeau, pustular bacterid of Andrews, and pustular psoriasis of Barber were 2, 17 and 5 respectively. The rest of remaining 11 cases were difficult to classify, so that these cases were defined as unclassified form. Those 36 cases of pustular erutions were compared with 42 cases of tinea pedis at manus s g n also in 1974. 3. The pustular eruptions showed relatively wider age distribution from 11~20 to 61~70 age groups but tinea pedis et manus revealed high incidence in 21~ 30 to 31~40 age groups. The ratio between both sexes were 13 male to 23 fema1e in pustular eruptions, while 26 to 16 in tinea pedis et manus. 4. The sites of involvement were mostly bilateral hands and feet or bilateral feet. 5. The nail involvement was seen in one third of 36 pustular eruptions. Pustular psoriasis and acrodermatitis continua showed higher incidence of nail involvement, while pustular bacterid and unclassified forms were very low. 6. The onset of both pustular eruptions and tinea pedis et manus showed high incidence in summer and next in spring. But the recrudescence was perenial in highest proportion among pustular eruptions, while tinea pedis et manus was in summer. 7. No direct relationships between pustular eruptions and psoriasis or focal infection was seen in its pathogenesis.
Acrodermatitis ; Age Distribution ; Dermatology ; Focal Infection ; Foot ; Gyeongsangbuk-do ; Hand ; Humans ; Incidence ; Male ; Outpatients ; Psoriasis ; Recurrence ; Tinea Pedis

PURPOSE: Infection is a major complication in patients with malignant disease. This study was performed to identify the causes and the etiologic agents of febrile infections and to characterize the clinical courses including the response to antimicrobial agents inpediatric cancer patients. METHODS: This study reviewed 274 febrile episodes occurring in 163 children with neoplastic disease which were indentified prospectively at Seoul National University Children's Hospital from January, 1991 to June, 1993. Neutropenia was defined as [granulocyte+band from] < or = 500mm(3). Each febrile episode was classified as a microbiologically documented infection(MDI), a clinically documented infection(CDI), and a probale infection(PI). The responses to initial antimicrobial atents were categorized into improvement, temporary improvement, failure, and not evaluable according to period to defervescence. RESULTS: Seventy seven percent of the febrile epidodes developed in neutropenic state. MDI were 98(36%), CDI 92(34%), and PI 84(30%) episodes. Bacteria were isolated in 75%, viruses in 13% and fungi in 11% of MDI. Fifty two episodes(19% of all) were associated with a bacteremia, and focal infections were indentified in 63% of bacteremia. The most frequent organisms causing MDI were E. coli(22%), K. pneumoniae(15%), S.epidermidis(7%). The great majority of infections other than bacteremia ocurred in the lung(32%), oral cavity(17%), skin and soft tissue(13%), and urinary tract(11%). The frequency of antimicrobial resistance of causative organisms was high. The responses to initial antimicrobial agents were improvement in 49%, temporary improvement in 13%, and failure in 38%. Patients with bacteremia responded less well than those with other categories. Mortality was 7% of total episodes. All of the fatal cases occurred in neutropenia and all but one had hematologic malignancies. CONCLUSIONS: This study documents the etiology and the type of infections and the responses to antimicrobial therapy in children with neoplastic diseases. The changes of causative agents and antimicrobial resistance should be considered in therapeutic strategies of cancer infection.
Anti-Infective Agents ; Bacteremia ; Bacteria ; Child* ; Focal Infection ; Fungi ; Hematologic Neoplasms ; Humans ; Mortality ; Neutropenia ; Prospective Studies ; Seoul ; Skin

Internal jugular vein catheter is frequently used for emergency hemodialysis. Various complications have been reported. Infection is one of the problem after long term use. There have been reports of osteomyelitis of clavicle secondary to subclavian catheterization but not osteomyelitis associated with internal jugular vein catheterization. There are two possible pathways of infection. One is hematogenous spread from another focus in the body or sepsis. The other is transmission of focal infection. Manipulation of the needle may perforate the vein and produce hematoma. The infected hematoma may have resulted in abscess formation around the rib and subsequent osteomyelitis. Herein we report a case of osteomyelitis of the rib complicating internal jugular vein catheterization with a review of the literature.
Abscess ; Catheterization ; Catheters* ; Clavicle ; Emergencies ; Focal Infection ; Hematoma ; Jugular Veins* ; Needles ; Osteomyelitis* ; Renal Dialysis ; Ribs* ; Sepsis ; Veins