Clostridium septicum(C.septicum)gas gangrene is well documented in the literature,typically in the setting of trauma or immunosuppression.In this paper,we report a unique case of spontaneous clostridial myonecrosis in...Clostridium septicum(C.septicum)gas gangrene is well documented in the literature,typically in the setting of trauma or immunosuppression.In this paper,we report a unique case of spontaneous clostridial myonecrosis in a patient with Crohn's disease and sulfasalazineinduced neutropenia.The patient presented with left thigh pain,vomiting and diarrhea.Blood tests demonstrated a profound neutropenia,and magnetic resonance imaging of the thigh confirmed extensive myonecrosis.The patient underwent emergency hip disarticulation,followed by hemicolectomy.C.septicum was cultured from the blood.Following completion of antibiotic therapy,the patient developed myonecrosis of the right pectoral muscle necessitating further debridement,and remains on lifelong prophylactic antibiotic therapy.展开更多
Background/Aims: High-resolution oesophageal manometry utilises water swallows to evaluate oesophageal function. However, small volumes of water are not representative of normal eating and as a result often produce no...Background/Aims: High-resolution oesophageal manometry utilises water swallows to evaluate oesophageal function. However, small volumes of water are not representative of normal eating and as a result often produce normal manometry studies in patients with dysphagia. This study sets out to establish optimal diagnostic thresholds for semi-solid solid swallows and evaluate their ability to uncover motility abnormalities in patients with motility disorders. Method: Manometry was performed using ten 5-mL single water swallows followed by two semi-solid and two solid swallows in the upright position. Normative values for the adjunctive tests were obtained from patient controls while patients with major motility disorders were used to establish the optimal diagnostic thresholds. Diagnostic thresholds identified were prospectively tested in patients with normal water swallows but oesophagus related symptoms and in those with minor and major motility disorders. Results: Normal values for semi-solid and solid were determined in patient controls (n = 100). Development of diagnostic thresholds included 120 patients with major motility disorders. Optimal diagnostic thresholds identified for oesophagogastric junction dysfunction in semi-solid and solid swallows (IRP > 15.5 mmHg). Hypercontractilty and spasm used existing thresholds (>8000 mmHg-s-cm and < 4.5 s, respectively) but modified frequency of ≥50% of adjunctive swallows. Diagnostic thresholds were applied to symptomatic patients with normal water swallows (n = 70) identifying 12/70 (17%) to have abnormal adjunctive swallows. One of 30 patients (3%) with ineffective motility had abnormal adjunctive swallow and 12 patients with oesophageal spasm, oesophagogastric junction obstruction, and hypercontractility had abnormal adjunctive swallows that moved them up the motility disorder hierarchy. Conclusions: Semi-solid and solid challenge increase diagnostic yield of motility disorders.展开更多
文摘Clostridium septicum(C.septicum)gas gangrene is well documented in the literature,typically in the setting of trauma or immunosuppression.In this paper,we report a unique case of spontaneous clostridial myonecrosis in a patient with Crohn's disease and sulfasalazineinduced neutropenia.The patient presented with left thigh pain,vomiting and diarrhea.Blood tests demonstrated a profound neutropenia,and magnetic resonance imaging of the thigh confirmed extensive myonecrosis.The patient underwent emergency hip disarticulation,followed by hemicolectomy.C.septicum was cultured from the blood.Following completion of antibiotic therapy,the patient developed myonecrosis of the right pectoral muscle necessitating further debridement,and remains on lifelong prophylactic antibiotic therapy.
文摘Background/Aims: High-resolution oesophageal manometry utilises water swallows to evaluate oesophageal function. However, small volumes of water are not representative of normal eating and as a result often produce normal manometry studies in patients with dysphagia. This study sets out to establish optimal diagnostic thresholds for semi-solid solid swallows and evaluate their ability to uncover motility abnormalities in patients with motility disorders. Method: Manometry was performed using ten 5-mL single water swallows followed by two semi-solid and two solid swallows in the upright position. Normative values for the adjunctive tests were obtained from patient controls while patients with major motility disorders were used to establish the optimal diagnostic thresholds. Diagnostic thresholds identified were prospectively tested in patients with normal water swallows but oesophagus related symptoms and in those with minor and major motility disorders. Results: Normal values for semi-solid and solid were determined in patient controls (n = 100). Development of diagnostic thresholds included 120 patients with major motility disorders. Optimal diagnostic thresholds identified for oesophagogastric junction dysfunction in semi-solid and solid swallows (IRP > 15.5 mmHg). Hypercontractilty and spasm used existing thresholds (>8000 mmHg-s-cm and < 4.5 s, respectively) but modified frequency of ≥50% of adjunctive swallows. Diagnostic thresholds were applied to symptomatic patients with normal water swallows (n = 70) identifying 12/70 (17%) to have abnormal adjunctive swallows. One of 30 patients (3%) with ineffective motility had abnormal adjunctive swallow and 12 patients with oesophageal spasm, oesophagogastric junction obstruction, and hypercontractility had abnormal adjunctive swallows that moved them up the motility disorder hierarchy. Conclusions: Semi-solid and solid challenge increase diagnostic yield of motility disorders.
